Pain under the left shoulder bladeobserved in musculoskeletal pathologies (osteochondrosis, myofascial syndrome, injuries), heart diseases (myocardial infarction, angina pectoris, rheumatic and non-rheumatic carditis), gastrointestinal diseases (pancreatitis, stomach ulcer). Rare causes of symptoms include damage to the spleen, ulcers, and skin tumors. Diagnostic methods are selected based on the basic syndrome: X-ray, ultrasound and endoscopic examinations are used. Analgesics are prescribed to relieve pain, after which medical or surgical treatment of the underlying disease is carried out.
Causes of pain under the left shoulder blade
Radicular syndrome
The pathological condition develops with thoracic osteochondrosis or intervertebral hernia. Less often, radicular pain occurs in spondylolisthesis and ankylosing spondylitis. Acute pain in the projection of the left scapula is observed when the 3rd - 6th are involved in the process. thoracic roots; discomfort directly under the scapula indicates the localization of damage in the 7th -8th. Typically, the pain spreads from the scapula to the lateral surface of the chest and intercostal spaces.
Myofascial pain syndrome
Bad posture and prolonged stay in an uncomfortable position lead to constant muscle tension. The syndrome manifests itself as pain in the shoulder blade area on the left side, when the load is predominantly on this side. The patient feels the discomfort as deep and moderately intense. At first, the pain is felt only during movement and effort, but over time it becomes constant. Sometimes there is radiating pain in the forearm or left hand.
Injuries
Intense pain occurs after a crack or fracture of the scapula or a bruise of the soft tissue above this area. If the integrity of the bone is preserved, the pain is moderate, the person can take a deep breath and move freely. When there is traumatic damage to bone structures, sharp pain occurs, and the mobility of the arm and shoulder girdle is often limited. When changing the position or pressing on the injured area, a sharp pain is felt.
Ulcers and carbuncles
Purulent inflammation of the skin surrounding the left scapula is accompanied by intense pain, which, as a rule, is clearly localized. As the ulcer matures, there is a "pulling" sensation, which intensifies when the area of inflammation is palpated or rubbed with clothing. After the rubber is punctured and the necrotic core is released, the pain subsides. With carbuncles, the pain is more intense, and the general condition of the patient often worsens.
Heart disease
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 innervation characteristics. In this case, the symptoms are accompanied by chest pains of various types, a feeling of freezing or interruptions in the work of the heart. Tachycardia and other rhythm disturbances are usually detected. Pain under the shoulder blade is manifested as:
- Myocardial infarction.Patients feel an unbearable burning sensation that spreads from the precordial region to the left arm and shoulder blade, and less often to the collarbone and neck. The condition appears suddenly and is accompanied by a strong fear of death and fainting.
- Stable angina.Episodes of squeezing or pressing pain radiating to the subscapular region are specific to attacks of ischemic heart disease. Unpleasant symptoms are caused by physical activity or emotional stress and last on average up to 10-15 minutes. After resting or taking nitrates, the pain disappears.
- Inflammatory heart diseases.Acute carditis (myocarditis, pericarditis) is characterized by dull or stabbing pain in the chest, which radiates to the left shoulder blade and torments the patient for several days. The person also complains of shortness of breath, elevated body temperature and swelling of the lower extremities.
- Rheumatism.The clinical picture of rheumatic carditis is characterized by radiating pain in the left half of the back in combination with cardialgia. The clinical picture is completed by arthralgia, annular erythema on the skin and rheumatic nodules. Symptoms are more often detected in children and adolescents.
Pancreatitis
Pain in the belt moving from the left hypochondrium to the subscapular region is observed in acute inflammation of the pancreas. In addition to the pain syndrome, patients are concerned about exhausting vomiting with impurities of bile and mucus, and tension in the abdominal muscles. The movement intensifies the painful sensations, so the person tries to lie motionless on his side.
In chronic pancreatitis, radiating pain under the scapula indicates worsening of the process. Often violations are caused by mistakes in 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 occur within 20-50 minutes after finishing the meal. The sooner symptoms appear, the higher the ulcer is. The discomfort becomes even more pronounced when you eat 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 area occurs with splenomegaly caused by infectious, autoimmune or myeloproliferative processes. With the gradual enlargement of the organ, there is periodic discomfort with heaviness in the affected area, and a rapid change in the size of the spleen is accompanied by sharp cutting pains radiating under the left shoulder blade.
Somewhat less often, the cause of pain is surgical pathologies of the spleen: rupture, infarction, volvulus. In this case, there are cutting or throbbing pains radiating under the shoulder blade, which are aggravated by the slightest movement. Therefore, the patient takes a forced position: he lies on his left side or on his back with his knees pulled to his stomach. The clinical picture is complemented by a sudden drop in blood pressure and tachycardia. In the absence of adequate pain relief, 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. Pain has a varied nature: sharp, stabbing, dull, pressing. They are accompanied by fever, shortness of breath and other typical respiratory symptoms. Pain under the left shoulder blade is most often experienced by patients who develop:
- Pneumonia.The patient feels moderate dull pain, which has a clear localization in the case of focal pneumonia or spreads over the entire scapular area in the case of lobar pneumonia. A deep cough occurs with the release of mucopurulent sputum. Symptoms last up to 2-4 weeks.
- Pleurisy.In exudative pleurisy, a person experiences pressure and cracking under the shoulder blade and along the side wall of the chest. When you feel this area, the discomfort intensifies. Dry pleurisy is characterized by acute pain in the chest and subscapular area, which intensifies 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 shoulder blade area, it is more likely that the pathological focus will be in the posterior segments of the lungs.
- Lung infarction.The death of part of the lung parenchyma is manifested by severe pain radiating under the left shoulder blade, clinically reminiscent of an angina attack. The patient's condition is complicated by hemoptysis or pulmonary bleeding, external breathing disorder and arrhythmias.
Rare causes
- Neoplasms: osteoma and osteosarcoma, bone cyst, malignant tumors of the skin above the shoulder blade (basal cell carcinoma, melanoma).
- Rare cardiovascular pathologies: cardiac syndrome X, aneurysm of the descending aorta.
- Acute surgical diseases: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
Diagnostics
Patients with pain under the left scapula are first referred to an orthopedic traumatologist. If there are no disorders of the musculoskeletal system, other specialists are included in the diagnostic examination: neurologist, cardiologist, surgeon, etc. To determine the cause of pain, a whole series of instrumental studies is prescribed, which includes:
- Radiography.X-ray of the scapula in frontal and lateral projection allows to rule out or confirm a traumatic injury. Radiographic imaging of the spine is indicated for suspected osteochondrosis, scoliosis or spondylolisthesis. A plain radiograph of the chest cavity makes it possible to suspect damage to the lungs or heart.
- Electrocardiogram.A standard 12-lead 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 electrophysiology of the heart.
- Abdominal ultrasound.A quick and non-invasive method is used to detect common conditions that cause pain in the left shoulder blade. Ultrasound examination shows signs of gastric ulcer, inflammatory infiltration of the pancreas and an enlarged spleen. To clarify the diagnosis of peptic ulcer, EGD is used.
- Additional methods. To clarify the nature and severity of bone changes, CT or MRI of the spine is performed. In case of possible bronchopulmonary diseases, bronchoscopy with biopsy and pleural puncture is performed. If there are difficulties in diagnosing abdominal pathology, diagnostic laparoscopy is recommended.
Laboratory testing methods play an important role in establishing a diagnosis. A clinical blood test shows signs of inflammation or disorders of hematopoietic processes. Acute phase protein indicators and proteinograms are informative in case of possible heart damage or autoimmune process. Specific myocardial markers are evaluated for anginal pain.
To diagnose gastrointestinal diseases, a co-program is carried out: 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 the case of inflammatory processes of the lungs and pleura, bacteriological seeding of biomaterials is required, followed by a test for the sensitivity of isolated microorganisms to antibiotics.
Treatment
Help before diagnosis
Given the various causes of pain under the left shoulder blade, it is extremely difficult for a doctor to make recommendations until the underlying pathology is identified. 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 permanent pain symptoms. If the sensations are unbearable, analgesics are used and the patient is immediately hospitalized.
Conservative therapy
The treatment plan is chosen 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 use of narcotic analgesics are effective. Taking into account the disease, the method of physical activity is chosen.
Drug therapy is prescribed by a specialist of the appropriate profile. For pain due to heart damage, the cardiologist prescribes antianginal and antiarrhythmic drugs, antiplatelet agents and anticoagulants, and antihypertensives. Diseases of the bronchopulmonary system require the participation of a pulmonologist and the use of antibiotics, expectorants and specific drugs against tuberculosis.
For gastrointestinal pathologies, a suitable diet is selected and the therapy supplemented with enzyme preparations, prokinetics, antacids and antisecretory drugs. In neurology, neurometabolic agents, B vitamins and drugs that improve microcirculation and blood rheological properties are indicated for the elimination of radicular syndrome.
Non-drug methods are actively used for posture disorders and other problems with the spine: traction therapy, therapeutic massage, exercise therapy. Balneotherapy (sulphide and radon baths), mud therapy and reflexology are popular among physiotherapeutic methods. The effectiveness of drug treatment can be increased by electrophoresis of drugs directly on the affected area.
Operation
Surgical methods are indicated when conservative treatment is ineffective or in acute life-threatening pathologies, when delay is dangerous to the patient's life and health. The second group of operations includes methods of stenting, angioplasty and bypass surgery for myocardial infarction, assistance of 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. In order to eliminate pain associated with compression of nerve structures, microdiscectomy and laser vaporization of the disc are performed. In rare cases, stabilization operations on the spine are resorted to (interbody fusion, application of the Halo device, transpedicular fixation).