Pain under 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 ulcers). Rare causes of this symptom include damage to the spleen, ulcers, and skin tumors. Diagnostic methods are selected based on the underlying syndrome: X-ray examination, ultrasound and endoscopy are used. To relieve pain, analgesics are prescribed, 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 commonly, radicular pain occurs in spondylolisthesis and ankylosing spondylitis. Acute pain in the projection of the left scapula is noted when the 3-6th thoracic root is involved in the process; discomfort directly under the scapula indicates localization of damage to the 7-8th vertebra. Typically, pain spreads from the shoulder blades to the lateral surfaces of the chest and intercostal spaces.
Myofascial pain syndrome
Poor posture and uncomfortable positions for long periods of time lead to constant muscle tension. This syndrome manifests itself as pain in the area of the scapula on the left, when the load is predominantly on this side. Discomfort is felt by the patient as deep and quite intense. At first, the pain is only experienced when moving and doing activities, but over time the pain becomes constant. Sometimes radiating pain appears in the left forearm or hand.
Injury
Severe pain occurs after a crack or fracture of the shoulder blade or bruising of the soft tissue in this area. If the integrity of the bones is maintained, the pain is moderate, the person can take a deep breath and move freely. When traumatic damage to bone structures occurs, sharp pain occurs, and the mobility of the arm and shoulder girdle is often limited. When changing position or pressing 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 is usually clearly localized. As the boil matures, a "pulling" sensation occurs, which increases when the area of inflammation is palpated or rubbed with clothing. Once the tire bursts and the necrotic core comes out, the pain decreases. With a carbuncle, the pain is more intense, and the patient's general condition often worsens.
Heart disease
Heart damage is a typical cause of pain under the left scapula, which is related to the anatomical proximity and innervation characteristics. In this case, the symptoms are accompanied by various types of pain in the chest, a feeling of freezing or disturbances in heart function. Tachycardia and other rhythm disturbances are usually detected. Pain under the shoulder blade manifests itself as:
- Myocardial infarction.The patient experiences an unbearable burning sensation that spreads from the precordial area to the left arm and shoulder blade, and less often to the collarbone and neck area. This condition occurs suddenly and is accompanied by a strong fear of death and fainting.
- Stable angina.Episodes of squeezing or pressing pain that radiate to the subscapular area are specific to attacks of ischemic heart disease. Unpleasant symptoms are triggered by physical exertion or emotional stress and last up to 10-15 minutes on average. After rest or taking nitrates, the pain goes away.
- Inflammatory heart disease.Dull or stabbing pain in the chest, radiating to the left shoulder blade and bothering the patient for several days, is characteristic of acute carditis (myocarditis, pericarditis). The person also complains of shortness of breath, increased body temperature, and swelling of the lower extremities.
- Rheumatic.Radiating pain in the left side of the back combined with cardialgia is a characteristic clinical picture of rheumatic carditis. The clinical picture is complemented by arthralgia, ring-shaped erythema of the skin, and rheumatic nodules. Symptoms are more frequently detected in children and adolescents.
Pancreatitis
Girdle pain migrating from the left hypochondrium to the subscapular region is observed with acute inflammation of the pancreas. In addition to the pain syndrome, patients are worried about debilitating vomiting with impurities of bile and mucus, as well as tension in the abdominal muscles. Movement increases the sensation of pain, so the person tries to lie on their side without moving.
In chronic pancreatitis, radiating pain below the shoulder blade indicates a worsening process. Often violations are triggered by errors in the diet - large parties, drinking alcohol. The pain is paroxysmal, sometimes spreading not only to the subscapularis, but also to the precordial region. Symptoms are combined with nausea, flatulence and steatorrhea.
Gastric pains
Pain under the left shoulder blade is a sign of localization of the defect on the back wall of the abdomen, closer to the back. Unpleasant sensations appear within 20-50 minutes after finishing eating. The earlier the symptoms appear, the higher the ulcer is located. Discomfort becomes worse when eating sour, spicy or fried foods. To reduce the intensity of pain, the patient induces vomiting.
Spleen disease
Pain and fullness in the left subscapular region occur with splenomegaly caused by infectious, autoimmune or myeloproliferative processes. With gradual enlargement of the organ, periodic discomfort develops with a feeling of heaviness in the affected area, and a rapid change in the size of the spleen is accompanied by sharp pain radiating under the left shoulder blade.
Somewhat less often, the cause of pain is surgical pathology of the spleen: rupture, infarction, volvulus. In this case, there is a cutting or throbbing pain radiating under the shoulder blade, which is aggravated by the slightest movement. Therefore, the patient takes a forced position: lying on his left side or on his back with his knees pressed to his stomach. The clinical picture is complemented by a sharp drop in blood pressure and tachycardia. If there is no adequate pain relief, shock will occur.
Bronchopulmonary pathology
Left-sided focal processes in the lung often cause pain in the scapular projection. Discomfort increases with deep breathing, laughing and talking, as well as coughing attacks. The pain is of various nature: sharp, stabbing, dull, pressing. Accompanied by fever, shortness of breath, and other typical respiratory symptoms. Most often, pain under the left shoulder blade is experienced by patients who experience:
- Pneumonia.The patient feels moderate dull pain, which has a clear localization in focal inflammation of the lung or spreads throughout the scapular region in lobar pneumonia. A deep cough appears with the discharge of mucopurulent sputum. Symptoms last up to 2-4 weeks.
- Pleurisy.With exudative pleurisy, a person experiences pressure and rupture under the shoulder blades and along the side walls of the chest. When you feel this area, the discomfort gets worse. Dry pleurisy is characterized by acute pain in the chest and subscapular region, which is aggravated by movement.
- TB.Tuberculosis infection lasts a long time, so low-intensity pain persists for several months. If the pain is localized in the scapular region, the pathological focus is more likely to be located in the posterior segments of the lung.
- Lung infarction.The death of part of the lung parenchyma is manifested by severe pain radiating under the left shoulder blade, clinically resembling an angina attack. The patient's condition was complicated by hemoptysis or pulmonary bleeding, external respiratory dysfunction, and arrhythmia.
Rare causes
- Neoplasm: osteoma and osteosarcoma, bone cysts, malignant tumors of the skin above the shoulder blades (basal cell carcinoma, melanoma).
- Rare cardiovascular pathology: heart syndrome X, descending aorta aneurysm.
- Acute surgical disease: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
Diagnostic
Patients with pain under the left shoulder blade are first referred for consultation to an orthopedic trauma specialist. If there are no disorders of the musculoskeletal system, other specialists are involved in the diagnostic search: neurologist, cardiologist, surgeon, etc. To determine the cause of pain, a series of instrumental studies is prescribed, which includes:
- Radiography.X-ray of the scapula in frontal and lateral projections allows one to exclude or confirm traumatic injury. Radiation imaging of the spine is indicated for suspected osteochondrosis, scoliosis, or spondylolisthesis. Plain radiography of the chest cavity allows one to suspect damage to the lungs or heart.
- Electrocardiogram.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 classical or transesophageal echocardiography and cardiac electrophysiology.
- Ultrasound of abdominal organs.A quick, non-invasive method is used to detect common conditions that cause pain in the left shoulder blade. Ultrasound examination showed signs of gastric ulcer, inflammatory infiltration of the pancreas, and enlargement of the spleen. To clarify the diagnosis of gastric ulcer, EGD is used.
- Additional Methods. To clarify the nature and severity of bone changes, CT or MRI of the spine is performed. If there is a possibility of bronchopulmonary disease, bronchoscopy with biopsy and pleural puncture is performed. If there are difficulties in diagnosing abdominal pathology, diagnostic laparoscopy is recommended.
Laboratory examination methods play a major role in establishing a diagnosis. Clinical blood tests show signs of inflammation or disorders of the hematopoietic process. Acute phase protein indicators and proteinogram are informative in case of possible heart damage or autoimmune processes. Specific myocardial markers were assessed for angina pain.
To diagnose gastrointestinal diseases, a joint 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 granules. In case of inflammatory processes in the lungs and pleura, bacteriological seeding of the biomaterial is necessary, followed by a test for the sensitivity of the isolated microorganism to antibiotics.
Treatment
Help before diagnosis
Given the variety of causes of pain under the left shoulder blade, it is very 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 excessive activity that can cause persistent pain symptoms. If the sensation is unbearable, analgesic drugs are used and the patient is immediately hospitalized.
Conservative therapy
The treatment plan is selected only after complete diagnosis and determination of the etiological factor of pain under the left shoulder blade. If the patient suffers from severe discomfort, anti-inflammatory drugs and muscle relaxants are recommended, which quickly eliminate painful sensations. For severe pain, therapeutic blockade and administration of narcotic analgesics are effective. Taking into account the disease, the means of physical activity are selected.
Drug therapy is prescribed by a specialist of the appropriate profile. For pain due to heart damage, cardiologists prescribe antianginal and antiarrhythmic drugs, antiplatelet and anticoagulant drugs, and antihypertensive drugs. Diseases of the bronchopulmonary system require the participation of a pulmonologist and the use of certain antibiotics, expectorants and anti-tuberculosis drugs.
For gastrointestinal pathologies, an appropriate diet is selected and therapy is supplemented with enzyme preparations, prokinetics, antacids and antisecretory drugs. In neurology, neurometabolic agents, B vitamins, and drugs that improve microcirculation and rheological properties of blood are indicated to eliminate radicular syndrome.
For posture disorders and other spinal problems, non-drug methods are actively used: traction therapy, therapeutic massage, exercise therapy. Among physiotherapeutic methods, balneotherapy (sulfide and radon baths), mud therapy and reflexology are popular. The effectiveness of drug treatment can be increased by electrophoresis of drugs directly to the affected area.
Operation
Surgical methods are indicated when conservative treatment is ineffective or with acute life-threatening pathology, when delay is dangerous for the life and health of the patient. The second group of operations includes methods of stenting, angioplasty and bypass surgery for myocardial infarction, assistance of an abdominal or thoracic surgeon for injuries, purulent processes and internal bleeding.
Planned surgical intervention is often prescribed in neurosurgery for severe radicular syndromes and intervertebral hernias. 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 performed (interbody fusion, application of the Halo device, transpedicular fixation).