Painful sensations under the scapula - This symptom can be encountered by adults suffering from musculoskeletal system disorders or internal organ pathology and children who simply did not calculate physical activity or were left on a draft.
Self-administration of analgesics when subscapular pain occurs is absolutely unacceptable: these sensations of pain can be a sign of life-threatening conditions.
At the same time, attention, and often emergency medical care, deserves not only a sharp pain, but also a dull pain under the left shoulder blade.
The nature of the pain and the symptoms that accompany it help to suggest a specific illness. However, only a qualified physician, based on the patient's complaints, will be able to understand the damage to which organ caused the pain, prescribe the necessary diagnostic test and, if necessary, provide emergency care.
Causes of pain under the left shoulder blade in the back behind
The proximity of the lungs, heart and spine, as well as an extensive network of nerve fibers, expands the list of possible causes of subscapular pain. In this case, each illness is characterized by other specific signs, and the nature and duration of the pain sensations also change.
Pathology of the musculoskeletal system and nerves
Diseases of the spine and back muscle structure are a common cause of left subscapular pain. Pain in these illnesses is usually unilateral.
- Osteochondrosis - the formation of osteophytes in the thoracic or cervical spine causes pulls to the left or right, starting in the neck and upper back and ending with irradiation in the arm. Pain does not disappear at rest, often prolonged, but bearable.
- Intercostal neuralgia - accompanied by severe pain spreading throughout the intercostal space and made worse by breathing, twisting, sneezing/coughing. Often, in neuralgia, the skin's sensitivity about the source of pain also changes. Neuralgia causes paraesthesia in the form of chills, while numb pain under the left shoulder blade usually occurs with myocardial infarction, angina pectoris.
- Scapular rib syndrome - is a "reward" for hard physical work or activities associated with a long stay in the same position (office workers). People complain of dull, dull pain located between the neck and shoulder, radiating under the scapula.
Important! The causes of pain under the left scapula, in the posterior part of the back, which radiates to the arm and are of an urgent nature - osteochondrosis and angina pectoris - have a distinguishing feature. With angina pectoris, the pain lasts up to 30 minutes, with osteochondrosis - several days. Also, an attack of angina pectoris is stopped with nitroglycerin or other cardiac drugs.
Sometimes, pain in the subscapularis is caused by myositis (while rigidity of movement and tension in certain muscle groups is observed), injuries to the scapula (sharp pain, always preceded by a fall, blow, etc. ) or oncology (may pain occurs periodically, not severe). Bone tuberculosis, that is, defeat of the scapula, cannot be ruled out.
Heart and Blood Vessel Diseases
Cardiac pathology is one of the most dangerous, which can be diagnosed when the patient complains of pain in the subscapularis. In this case, pain in heart disease does not always start on the front surface of the chest (behind or to the left of the chest). The cause of pain under the left shoulder blade, in the heart area, could be:
- Angina pectoris - pressure pain behind the sternum that extends under the left scapula and collarbone, in the jaw and in the upper arm. Pain intensity is reduced at rest, but the change in body position does not bring relief. In scapular-costal (vertebrogenic) syndrome, the situation with increased pain is radically opposite. The attack of angina pectoris is leveled by ingestion of nitroglycerin, with spinal pain, manual therapy is excellent.
- Myocardial infarction is a sharp, escalating pain in the heart, with characteristic radiation to the left (including under the scapula), uninterrupted by cardiac glycosides. The patient feels intense fear, which is not the case with spinal and nerve fiber injuries. Requires immediate hospitalization!
- Hypertensive crisis - often accompanied by severe heart pain radiating to the left shoulder. The cause of pain is easily determined by measuring a/d.
- Pericarditis - In this disease, pain decreases at rest and when the trunk is bent forward. Pain arises in the anterior area of the heart, radiating under the scapula, but not as intense as in acute myocardial ischemia (angina pectoris, heart attack).
- Detachment, an aortic aneurysm, is a dangerous condition characterized by throbbing pain under the scapula. The rapid increase in pain requires an urgent call from the medical team.
Important! Both for ischemic heart disease (angina pectoris, heart attack) and for cervical osteochondrosis, numbness of the tongue on the left is characteristic.
Important! Frequently, a symptomatic picture similar to cardiac pathology is given by vegetative-vascular dystonia. At the same time, the demonstration of his serious condition is clearly faked (psychogenic factor), the patient is often nervous, shivering, has a fever and a sensation of a lump in the throat.
Respiratory diseases
Pain under the left scapula can cause the following lung diseases:
- Pneumonia - causes pain only when the inflammatory focus is located close to the pleural membrane. Painful sensations of low intensity arise periodically, have a punctual location and intensify with breathing.
- Pleurisy - unlike pneumonia, the pain is sharp, piercing. Its intensity depends on the depth of breathing.
Concomitant pulmonary symptoms accompanying pain on inhaling under the left shoulder blade are shallow, rapid breathing, shortness of breath, fever. Hyperthermia can also occur with pericarditis. It is extremely rare to have a slight increase in temperature with severe neuralgia, myositis.
Important! Unlike heart disease, with respiratory tract pathology, pain is accompanied by night sweats and coughing (in the initial stage of pneumonia and with pleurisy - drought).
gastrointestinal tract pathology
Pain under the scapula often accompanies gastrointestinal illnesses. In this case, the symptomatic image is as follows:
- Peptic ulcer - intense cutting pain is always associated with food ingestion (occurs before or immediately after eating), radiating to the scapula with nonspecific location of the ulcerative process (posterior wall of the stomach or its cardiac part). Pain decreases after vomiting by taking acid-lowering drugs. The perforation of the ulcer is accompanied by increased pain (knife cutting), the patient presses the legs against the stomach and covers them with his hands.
- Pancreatitis - accompanied by severe waist-like pain (including under the left shoulder blade). An attack is always associated with errors in nutrition (fatty foods, salty foods, fried foods, alcohol, hunger). Vomiting does not bring relief.
Important! The pathology of the gastrointestinal tract, which caused pain under the scapula on the left side, is accompanied by other characteristic symptoms - bloating, indigestion, vomiting, belching.
Diagnosis of subscapular pain
When taking the anamnesis, the physician pays attention to the relationship between pain and physical activity, food intake, stress, and also specifies chronic and recent concomitant diseases.
Assessing the nature of pain, the presence of certain specific symptoms of diseases of different organs allows to narrow the range of causes to a specific system of the body - the heart, lungs, musculoskeletal system, gastrointestinal tract. The preliminary diagnosis is confirmed by the following studies:
- heart - a/d measurement, ECG, echocardiography and Doppler scan;
- lungs - chest X-ray;
- spine - radiography of the cervical and thoracic regions, computed tomography or magnetic resonance imaging.
In the future, a more detailed examination of the damaged organ may be necessary. Only then is the treatment of the identified disease prescribed.
When and which doctor should I contact?
Depending on the degree of intensity and nature of the painful sensations under the scapula, following the symptoms, you should consult a doctor:
- urgent call for emergency care - acute pain with increasing intensity and rapid deterioration of general condition;
- traumatologist - receiving an injury that caused pain syndrome;
- cardiologist - with concomitant chest pain (constant or periodic), shortness of breath, cyanosis;
- neurologist, orthopedist - pain under the left shoulder blade, aggravated by arm elevation, there is a clear link between the occurrence of pain and physical activity, previously diagnosed degenerative spinal pathology;
- gastroenterologist - there is a link between pain and food intake, there are other signs of gastrointestinal illnesses (nausea, vomiting, etc. );
- pulmonologist - pain under the scapula is accompanied by coughing, shortness of breath;
- therapist - the pain occurs without a clear cause, permanent or temporary.
It is the therapist who often diagnoses a trivial VSD and finds confirmation of an acute surgical pathology or cancer process. In the future, the doctor makes an appointment with a restricted specialist.
Preliminary Treatment Regimes
Depending on the diagnosis, the treating physician selects an effective treatment for the causative disease. An important point in complex therapy is the elimination of the pain syndrome:
- For neurological pain, strong pain relievers are most often used;
- Spine and muscle pathology requires a course of nonsteroidal anti-inflammatory drugs;
- Heart disease - the painful syndrome requires ingestion of nitroglycerin (does not help in heart attack), Validol has only a reflex effect and does not improve the condition of the heart muscle in ischemic disease in any way;
- If you suspect a gastrointestinal illness, it is advisable to take antispasmodics, acid-lowering medications (with ulcers).
Only by eliminating the causing disease, the patient gets rid of the pain under the scapula. In acute conditions, urgent hospitalization and intensive treatment are sometimes required.
The radical nature of the treatment depends on the nature of the disease and the duration of its course, therefore, the doctor must be consulted at the first painful symptoms. It is not just the outcome of the illness that depends on it, and the chances of a full recovery increase.
In severe cases, timely medical care saves the patient's life.