Pain under the left shoulder bladeobserved in pathologies of the musculoskeletal system (osteochondrosis, myofascial syndrome, injuries), heart diseases (myocardial infarction, angina pectoris, rheumatic and non-rheumatic carditis), gastrointestinal diseases (pancreatitis, gastric ulcers). Rare causes of the symptom include damage to the spleen, ulcers, and skin tumors. Diagnostic methods are selected based on the main syndrome: X-ray, ultrasound and endoscopic examinations are used. Analgesics are prescribed to relieve pain, followed by medical or surgical treatment of the underlying disease.
Causes of pain under the left shoulder blade
Radicular syndrome
The pathological condition develops with thoracic osteochondrosis or intervertebral hernia. Less commonly, radicular pain occurs with spondylolisthesis and ankylosing spondylitis. Sharp pain in the projection of the left scapula is noted when the 3-6th thoracic roots are involved in the process; discomfort directly under the scapula indicates the localization of the damage in the 7-8th vertebrae. Usually, the pain spreads from the scapula to the lateral surface of the chest and intercostal spaces.
Myofascial pain syndrome
Poor posture and prolonged sitting in an uncomfortable position lead to constant muscle tension. The syndrome manifests itself as pain in the shoulder blade area on the left when the load is mainly on that side. Discomfort is felt by the patient as deep and moderately strong. At first, the pain is felt only with movement and effort, but over time it becomes constant. Sometimes there is a radiating pain in the forearm or left hand.
Injuries
Intense pain develops after a crack or fracture of the scapula or bruising of the soft tissues in this area. If the integrity of the bone is preserved, the pain is moderate, the person can breathe deeply and move freely. In case of traumatic damage to the bone structures, sharp pain occurs, the mobility of the arm and shoulder girdle is often limited. When changing the position or putting pressure on the injured area, a sharp pain is felt.
Boils and carbuncles
Purulent inflammation of the skin around the left shoulder blade is accompanied by intense pain, which, as a rule, is clearly localized. As the boil matures, "pulling" sensations appear, which intensify when the area of inflammation is palpated or rubbed with clothing. Once the tire breaks through and the necrotic core comes out, the pain subsides. With a carbuncle, the pain is more intense and the general condition of the patient often worsens.
Heart diseases
Damage to the heart is a typical cause of pain under the left scapula, which is related to the proximity of the anatomical location and the characteristics of the innervation. In this case, the symptoms are accompanied by various types of pain in the chest, a feeling of freezing or interruption of the work of the heart. Tachycardia and other rhythm disturbances are usually detected. Pain under the scapula manifests itself as:
- Myocardial infarction.Patients experience unbearable burning sensations that spread from the precordial region to the left arm and scapula, and less often to the collarbone and neck region. The condition comes on suddenly and is accompanied by a strong fear of death and fainting.
- Stable angina pectoris.Episodes of pressing or pressing pain radiating to the subscapular region are specific to attacks of ischemic heart disease. Unpleasant symptoms are provoked by physical activity or emotional stress and last on average up to 10-15 minutes. After rest or intake of nitrates, the pain disappears.
- Inflammatory heart diseases.Dull or piercing pain in the chest, which radiates to the left shoulder blade and bothers the patient for several days, is typical of acute carditis (myocarditis, pericarditis). The person also complains of shortness of breath, increased body temperature and swelling of the lower extremities.
- rheumatism.Radiating pain in the left half of the back in combination with cardialgia is characteristic of the clinical picture of rheumatic carditis. The clinical picture is complemented by arthralgia, ring-shaped skin erythema and rheumatic nodules. Symptoms are more common in children and adolescents.
Pancreatitis
Pain in the girdle, which moves from the left hypochondrium to the subscapular region, is observed in acute inflammation of the pancreas. In addition to the pain syndrome, patients are worried about exhausting vomiting with impurities of bile and mucus and tension in the abdominal muscles. Movement increases painful sensations, so the person tries to lie motionless on his side.
In chronic pancreatitis, radiating pain under the scapula indicates an exacerbation of the process. Often the disorders are provoked by mistakes in the diet - a big feast, drinking alcohol. The pain is paroxysmal in nature, sometimes spreading not only to the subscapularis, but also to the precordial region. Symptoms are combined with nausea, flatulence and steatorrhea.
Stomach ulcer
Pain under the left shoulder blade is a sign of localization of the defect on the back wall of the stomach, closer to the back. Unpleasant sensations appear within 20-50 minutes after finishing the meal. The earlier the symptoms appear, the higher the location of the ulcer. Discomfort becomes stronger when eating sour, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.
Diseases of the spleen
Pain and a feeling of fullness in the left subscapular region occur with splenomegaly caused by infectious, autoimmune, or myeloproliferative processes. With the gradual increase of the organ, there is periodic discomfort with heaviness in the affected area, and the rapid change in the size of the spleen is accompanied by sharp cutting pains radiating under the left shoulder blade.
A little less often, the cause of the pain is surgical pathologies of the spleen: rupture, infarction, volvulus. In this case, there are cutting or throbbing pains radiating below the scapula, which are aggravated by the slightest movement. Because of this, the patient takes a forced position: lying on his left side or on his back with his knees drawn to his stomach. The clinical picture is complemented by a sharp drop in blood pressure and tachycardia. In the absence of adequate anesthesia, shock occurs.
Bronchopulmonary pathologies
Left-sided focal processes in the lungs often cause pain in the projection of the scapula. Discomfort increases with deep breathing, laughing and talking, and coughing fits. The pain has a varied character: sharp, stabbing, dull, pressing. They are accompanied by high fever, shortness of breath and other typical respiratory symptoms. Most often, pain under the left shoulder blade is experienced by patients who develop:
- Pneumonia.The patient feels moderate dull pain, which has a clear localization in case of focal inflammation of the lungs or spreads to the entire scapular area in case of lobar pneumonia. There is a deep cough with the release of mucopurulent sputum. Symptoms last up to 2-4 weeks.
- Pleurisy.With exudative pleurisy, a person experiences pressure and bursting under the shoulder blade and along the side wall of the chest. When you feel this area, the discomfort increases. Dry pleurisy is characterized by sharp pain in the chest and subscapular area, which increases during movement.
- Tuberculosis.Tuberculosis infection lasts a long time, so pain of low intensity lasts for several months. If the pain is localized in the area of the scapula, the pathological focus is more likely to be localized in the posterior segments of the lung.
- Pulmonary infarction.The death of part of the lung parenchyma is manifested by severe pain that radiates under the left shoulder blade, clinically resembling an angina attack. The condition of patients is complicated by hemoptysis or pulmonary hemorrhage, dysfunction of external breathing and arrhythmias.
Rare reasons
- New formations: osteomas and osteosarcomas, bone cysts, malignant tumors of the skin above the scapula (basal cell carcinoma, melanoma).
- Rare cardiovascular pathologies: cardiac syndrome X, aneurysm of the descending aorta.
- Acute surgical diseases: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
Diagnosis
Patients with pain under the left scapula are first referred for a consultation with an orthopedic traumatologist. If there are no disorders of the musculoskeletal system, other specialists are involved in the diagnostic search: neurologist, cardiologist, surgeon, etc. In order to establish the causes of the pain, a full set of instrumental studies is prescribed, which includes:
- Radiography.X-ray of the scapula in frontal and lateral projection allows to exclude or confirm a traumatic injury. Irradiation of the spine is indicated when osteochondrosis, scoliosis or spondylolisthesis is suspected. Plain radiography of the chest cavity allows suspicion of damage to the lungs or heart.
- Electrocardiogram.The standard 12-channel ECG is a screening method, based on the results of which the doctor makes a preliminary diagnosis and identifies dangerous processes (myocardial infarction, life-threatening arrhythmias). The diagnostic complex is complemented by classic or transesophageal echocardiography and cardiac electrophysiology.
- Ultrasound of abdominal organs.A quick and non-invasive method is used to detect common conditions causing pain in the left scapula. Ultrasound examination showed signs of gastric ulcer, inflammatory infiltration of the pancreas and an enlarged spleen. EGD is used to clarify the diagnosis of peptic ulcer.
- Additional methods. To clarify the nature and severity of bone changes, CT or MRI of the spine is performed. In case of probable bronchopulmonary diseases, bronchoscopy with biopsy and pleural puncture is performed. If there are difficulties in diagnosing abdominal pathology, diagnostic laparoscopy is recommended.
Laboratory research methods play a major role in making the diagnosis. The clinical blood test shows signs of inflammation or disruption of hematopoietic processes. Indicators of acute phase proteins and proteinograms are informative in case of possible cardiac damage or autoimmune process. Specific myocardial markers of anginal pain were evaluated.
To diagnose gastrointestinal diseases, a coprogram is performed: the presence of pancreatitis is indicated by a high content of undigested food particles, an increase in the number of striated muscle fibers and starch grains. In case of inflammatory processes of the lungs and pleura, bacteriological seeding of the biomaterial is necessary, followed by a sensitivity test of the isolated microorganisms to antibiotics.
Treatment
Help before diagnosis
Given the variety of causes of pain under the left shoulder blade, it is extremely difficult for a doctor to give recommendations until the underlying pathology is established. During the examination, it is recommended to reduce the load on the back muscles in order to eliminate simple fatigue and overstrain, which can cause constant symptoms of pain. If the sensations are unbearable, analgesics are used and the patient is immediately hospitalized.
Conservative therapy
The treatment plan is selected only after a complete diagnosis and determination of the etiological factors of pain under the left shoulder blade. If the patient suffers from severe discomfort, anti-inflammatory drugs and muscle relaxants are recommended, which quickly relieve painful sensations. In severe pain, therapeutic blockades and the application of narcotic analgesics are effective. Considering the disease, a mode of physical activity is selected.
Drug therapy is prescribed by a specialist with an appropriate profile. For pain due to damage to the heart, the cardiologist prescribes antianginal and antiarrhythmic drugs, antiplatelet and anticoagulant drugs, and antihypertensive drugs. Diseases of the bronchopulmonary system require the involvement of a pulmonologist and the taking of antibiotics, expectorants and specific anti-tuberculosis drugs.
In case of gastrointestinal pathologies, an appropriate diet is chosen and the therapy is supplemented with enzyme preparations, prokinetics, antacids and antisecretory drugs. Neurometabolic agents, vitamins of group B and drugs that improve microcirculation and rheological properties of blood are shown in neurology to eliminate radicular syndrome.
For postural disorders and other problems with the spine, non-drug methods are actively used: traction therapy, therapeutic massage, exercise therapy. Balneotherapy (sulphide and radon baths), mud therapy and reflexology are popular among physiotherapeutic methods. It is possible to increase the effectiveness of drug treatment by electrophoresis of drugs directly in the affected area.
surgery
Surgical methods are indicated when conservative treatment is ineffective or in acute life-threatening pathologies, when delay is dangerous to the life and health of the patient. The second group of operations includes methods of stenting, angioplasty and bypass for myocardial infarction, assistance from abdominal or thoracic surgeons for injuries, purulent processes and internal bleeding.
Planned surgical interventions are often prescribed in neurosurgery for severe radicular syndrome and intervertebral hernia. To eliminate the pain associated with compression of nerve structures, microdiscectomy and laser vaporization of the disc is performed. In rare cases, stabilization operations of the spine are resorted to (interdepartmental fusion, application of the Halo device, transpedicular fixation).