Pain below left shoulder blade

Pain below left shoulder bladeObserved in musculoskeletal diseases (osteochondrosis, myofascial syndromes, injuries), cardiac disease (myocardial infarction, angina, rheumatic and non-rheumatic heart disease), gastrointestinal diseases (pancreatitis, gastric ulcer). Rare causes of this condition include spleen damage, ulcers, and skin tumors. Choose a diagnostic method based on underlying symptoms: use X-rays, ultrasound, and endoscopy. To relieve pain, analgesics are prescribed, followed by medical or surgical treatment of the underlying condition.

Causes of pain below left shoulder blade

radiculopathy syndrome

The pathological condition develops with thoracic osteochondrosis or intervertebral hernia. Less commonly, radicular pain occurs with spondylolisthesis and ankylosing spondylitis. When the thoracic vertebrae 3-6 are involved in the procedure, severe pain is noted in the prominence of the left scapula; discomfort just below the scapula indicates damage to vertebrae 7-8. Typically, the pain radiates from the shoulder blades to the sides of the chest and between the ribs.

myofascial pain syndrome

Poor posture and staying in uncomfortable positions for long periods of time can lead to ongoing muscle tension. The syndrome presents with pain in the left scapular region, where the load is mainly concentrated on this side. The discomfort felt by the patient is deep and moderate in intensity. At first, the pain is only felt with movement and exertion, but over time, the pain becomes constant. Sometimes radiating pain occurs in the forearm or left hand.

Injuried

Severe pain can occur after a ruptured or fractured shoulder blade or bruising of the soft tissue in the area. If the integrity of the bone is preserved, the pain is moderate and the patient can breathe deeply and move freely. When a traumatic injury occurs to the bone structure, severe pain occurs and movement of the arm and shoulder girdle is often limited. Severe pain may be felt when changing position or pressing on the injured area.

Boils and carbuncles

Purulent inflammation of the skin around the left scapula is associated with severe pain and is usually markedly localized. As the boil matures, a "pulling" feeling develops, which is intensified when the inflamed area is palpated or rubbed with clothing. Once the tire ruptures and the necrotic core comes out, the pain will lessen. With carbuncles, the pain is more severe and the patient's general condition often worsens.

heart disease

Cardiac injury is a typical cause of pain below the left scapula, which is related to the proximity of the anatomy and the characteristics of the innervation. In this case, symptoms are accompanied by various types of chest pain, coldness, or disruption of heart function. Tachycardia and other rhythm disorders are often detected. Pain below the shoulder blade may appear as:

• Myocardial infarction.Patients experience an excruciating burning sensation that spreads from the precordium to the left arm and scapula, and rarely to the clavicle and neck areas. The condition occurs suddenly and is accompanied by intense fear of death and a fainting state.
• Stable angina.Episodes of squeezing or tenderness radiating to the subscapular area are characteristic of an ischemic heart attack. Physical activity or emotional stress can trigger unpleasant symptoms that last on average up to 10-15 minutes. The pain goes away with rest or taking nitrates.
• Inflammatory heart disease.Dull pain or tingling pain in the chest, radiating to the left scapula, bothering the patient for several days, is a typical symptom of acute carditis (myocarditis, pericarditis). The patient also complained of shortness of breath, increased body temperature, and lower extremity swelling.
• Rheumatism.Radiating pain in the left half of the back accompanied by heartache is a characteristic clinical manifestation of rheumatic carditis. Clinical manifestations are also accompanied by joint pain, annular erythema of the skin, and rheumatic nodules. Symptoms are more common in children and teenagers.

pancreatitis

In acute pancreatic inflammation, girdle pain moving from the left rib to the subscapular region can be observed. In addition to the pain syndrome, patients are concerned about vomiting with bile and mucus impurities, as well as tension in the abdominal muscles. Movement increases pain, so patients may try to lie still on their side.In chronic pancreatitis, radiating pain below the shoulder blades indicates an exacerbation of the process. Often, offending behavior is caused by dietary errors - eating large meals, drinking alcohol. The pain is paroxysmal in nature and sometimes affects not only the subscapularis but also the precordium. Symptoms also include nausea, gas, and steatorrhea.

gastric ulcer

Pain below the left shoulder blade is a sign of a localized defect in the posterior wall of the stomach (near the back). The unpleasant feeling can occur within 20-50 minutes after eating. The earlier symptoms appear, the higher up the ulcer is. The discomfort will be worse when eating sour, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.

spleen disease

Splenomegaly caused by infectious, autoimmune, or myeloproliferative processes can cause pain and fullness in the left subscapular area. As the organ gradually enlarges, there will be periodic discomfort and heaviness in the affected area, rapid changes in the size of the spleen, and sharp, cutting pain radiating below the left shoulder blade.Less commonly, the cause of pain is surgical pathology of the spleen: rupture, infarction, volvulus. In this condition, there is a cutting or throbbing pain that radiates below the shoulder blade and is aggravated by the slightest movement. Therefore, the patient assumes a forced position: lying on his left side or on his back with his knees close to his abdomen. Clinical manifestations are also accompanied by a sharp drop in blood pressure and tachycardia. Without adequate pain relief, shock can occur.

bronchopulmonary pathology

Lesions on the left side of the lung often cause pain at the prominence of the scapula. Deep breathing, laughing, talking, and coughing can make the discomfort worse. Pain comes in many qualities: sharp, stabbing, dull, and compressive. They are accompanied by fever, shortness of breath and other typical respiratory symptoms. Most commonly, pain below the left shoulder blade occurs in patients who:

• pneumonia.The patient will feel moderate dull pain. If it is focal lung inflammation, the pain will be clearly localized; if it is lobar pneumonia, the pain will spread to the entire scapula area. A deep cough occurs with mucopurulent sputum. Symptoms can last up to 2-4 weeks.
• pleurisy.With effusion pleurisy, patients experience pressure and ruptures under the shoulder blades and on the side walls of the chest. The discomfort increases when you touch the area. Dry pleurisy is characterized by acute pain in the chest and subscapular area that is worsened by movement.
• tuberculosis.Tuberculosis infection is long-lasting, so low-intensity pain may persist for several months. If the pain is localized to the scapular region, the pathological lesion is more likely to be located in the posterior segment of the lung.
• Pulmonary infarction.Death of part of the lung parenchyma manifests as severe pain radiating below the left scapula, clinically similar to an angina attack. The patient's condition is complex, accompanied by hemoptysis or pulmonary hemorrhage, external respiratory dysfunction, arrhythmia, etc.

Rare causes

• tumor: Osteoma and osteosarcoma, bone cysts, malignant tumors of the skin above the shoulder blade (basal cell carcinoma, melanoma).
• rare cardiovascular disease: Cardiac syndrome X, descending aortic aneurysm.
• acute surgical illness: Retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.

diagnosis

Patients with pain below the left shoulder blade are first referred to an orthopedic traumatologist for consultation. If there are no diseases of the musculoskeletal system, other specialists are involved in the diagnostic search: neurologists, cardiologists, surgeons, etc. To determine the cause of pain, a full range of instrumental studies is needed, including:

• Radiography.X-rays of the scapula in frontal and lateral projections can rule out or confirm trauma. Spine radiography is indicated for suspected osteochondrosis, scoliosis, or spondylolisthesis. A plain x-ray of the chest can raise suspicion of damage to the lungs or heart.
• Electrocardiogram.A standard 12-lead electrocardiogram is a screening method on the basis of which the doctor makes a preliminary diagnosis and identifies dangerous processes (myocardial infarction, life-threatening arrhythmias). The diagnostic complex is complemented by classical or transesophageal echocardiography and cardiac electrophysiology.
• Ultrasound examination of abdominal organs.Use a quick and non-invasive method to detect common conditions that cause left shoulder blade pain. Ultrasonography showed signs of gastric ulceration, pancreatic inflammatory infiltrate, and splenomegaly. To confirm the diagnosis of peptic ulcer, EGD is used.
• additional methods. To determine the nature and severity of the skeletal changes, a CT or MRI of the spine is required. If bronchopulmonary disease is possible, perform bronchoscopy, biopsy, and pleural puncture. If there is difficulty diagnosing abdominal pathology, diagnostic laparoscopy is recommended.

Laboratory test methods play an important role in diagnosis. Clinical blood tests show signs of inflammation or disruption of the hematopoietic process. Indicators of acute phase proteins and protein profiles can provide information on possible cardiac injury or autoimmune processes. Specific myocardial markers for assessment of angina. To diagnose gastrointestinal diseases, a synergistic procedure is performed: a high content of undigested food particles, an increased number of striated muscle fibers and starch granules indicate the presence of pancreatitis. If inflammation of the lungs and pleura occurs, it is necessary to perform a bacteriological inoculation of the biological material and then test the susceptibility of the isolated microorganisms to antibiotics.

treat

Pre-diagnosis help

Given the variety of causes of pain below the left shoulder blade, it's difficult for doctors to make recommendations until the underlying pathology is identified. During the examination, it is recommended to reduce the load on the back muscles to eliminate simple fatigue and overexertion, which can lead to persistent painful symptoms. If it feels unbearable, use painkillers and take the person to the hospital immediately.

Conservative treatment

Treatment options should be chosen only after a thorough diagnosis and determination of the cause of left subscapular pain. If the patient is experiencing severe discomfort, anti-inflammatory drugs and muscle relaxants are recommended to provide quick relief from pain. For severe pain, therapeutic blockade and administration of narcotic analgesics are effective. Choose patterns of physical activity with the disease in mind.Medications are prescribed by appropriately qualified specialists. For pain caused by heart damage, cardiologists prescribe antianginal and antiarrhythmic drugs, antiplatelet and anticoagulant drugs, and antihypertensive drugs. Bronchopulmonary disease requires the involvement of a pulmonologist and the use of antibiotics, expectorants, and specific antituberculous drugs.For gastrointestinal lesions, choose an appropriate diet supplemented by enzyme preparations, prokinetic agents, antacids and anti-secretory drugs. In neurology, neurometabolic drugs, B vitamins, and drugs that improve microcirculatory and hemorrheological properties eliminate radicular syndromes.For postural disorders and other spinal problems, non-pharmacological methods are actively used: traction therapy, therapeutic massage, exercise therapy. Among physical therapy methods, balneotherapy (sulfide baths and radon baths), mud therapy and reflexology are popular. The effectiveness of drug treatments can be increased by electrophoresis of the drug directly into the affected area.

Surgery

Surgical approaches are required when conservative treatments fail or when acute life-threatening conditions develop, when delay poses a danger to the patient's life and health. The second group of surgeries includes stent placement, angioplasty, and bypass surgery for myocardial infarction, as well as the assistance of an abdominal or thoracic surgeon for injuries, purulent processes, and internal bleeding.Neurosurgery often performs planned surgical intervention for severe radicular syndromes and intervertebral hernias. To eliminate the pain associated with compression of neural structures, microdiscectomy and laser disc vaporization are performed. In rare cases, spinal stabilization procedures (interbody fusion, application of a Halo device, transpedicular fixation) are performed.