Pain under left shoulder blade

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 the symptom include damage to the spleen, ulcers, and skin cancers. Diagnostic methods are selected depending on the underlying syndrome: radiographic, ultrasound and endoscopic examinations 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 with spondylolisthesis and ankylosing spondylitis. Acute pain in the projection of the left scapula is noted when the 3rd-6th thoracic roots are involved in the process; discomfort directly under the scapula indicates the localization of damage in the 7th-8th vertebra. Typically, the pain spreads from the scapula to the lateral surface of the chest and the intercostal spaces.

Myofascial pain syndrome

Poor posture and prolonged stay in an uncomfortable position lead to constant muscle tension. The syndrome manifests itself as pain in the area of the left scapula, when the load is predominantly on this side. The discomfort is perceived by the patient as deep and moderately intense. At first the pain is felt only during movement and effort, but over time it becomes constant. Sometimes radiating pain appears in the left forearm or hand.

Injuries

Severe pain develops after a crack or fracture of the scapula or a soft tissue bruise in this area. If the integrity of the bone is preserved, the pain is moderate, the person can take deep breaths 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 you change position or press on the injured area, you feel a sharp pain.

Boils 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 boil matures, "tugging" sensations occur, which intensify when the area of inflammation is palpated or rubbed with clothing. After the tire breaks through 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 associated with the proximity of the anatomical location and the characteristics of the innervation. In this case the symptoms are accompanied by chest pains of various types, a feeling of freezing or interruptions in the functioning of the heart. Tachycardia and other rhythm disturbances are usually detected. Pain under the shoulder blade manifests itself as:

• Heart attack.Patients experience unbearable burning sensations that spread from the precordial region to the left arm and shoulder blade, and less often to the collarbone and neck area. The condition occurs suddenly and is accompanied by a strong fear of death and a state of fainting.
• Stable angina.Episodes of crushing or pressing pain radiating to the subscapular area are specific to ischemic heart disease attacks. The unpleasant symptoms are provoked by physical activity or emotional stress and last on average up to 10-15 minutes. After resting or taking nitrates, the pain goes away.
• Inflammatory heart disease.Dull or stabbing pain in the chest, radiating to the left scapula and bothering 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-like erythema on the skin and rheumatic nodules. Symptoms are detected more often in children and adolescents.

Pancreatitis

Girdle pain moving from the left hypochondrium to the subscapular region is observed with acute pancreatic inflammation. In addition to pain syndrome, patients are concerned about debilitating vomiting with impurities of bile and mucus and tension in the abdominal muscles. Movement increases painful sensations, so the person tries to lie on his side motionless.

In chronic pancreatitis, irradiation of pain under the scapula indicates an exacerbation of the process. Often violations are provoked by errors in the diet: a big party, alcohol consumption. 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 posterior wall of the stomach, closer to the back. Unpleasant sensations appear within 20-50 minutes after the end of the meal. The earlier the symptoms appear, the higher the position of the ulcer. The discomfort becomes more severe when eating acidic, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.

Diseases of the spleen

Pain and sensation of fullness in the left subscapular area occur with splenomegaly caused by infectious, autoimmune, or myeloproliferative processes. With the gradual enlargement of the organ, periodic discomfort with heaviness develops in the affected area, and a rapid change in the size of the spleen is accompanied by severe cutting pains radiating under the left shoulder blade.

Slightly less frequently the cause of pain are surgical pathologies of the spleen: rupture, infarction, volvulus. In this case, sharp or stabbing pains occur that radiate under the shoulder blade, which worsen at the slightest movement. Therefore, the patient takes a forced position: lying on his left side or back with his knees bent to his stomach. The clinical picture is complemented by a sharp drop in blood pressure and tachycardia. In the absence of adequate pain relief, shock occurs.

Bronchopulmonary diseases

Focal processes of the left side of the lungs often cause pain in the projection of the scapula. The discomfort increases with deep breathing, laughing, talking and with a coughing fit. The pain has a varied nature: acute, stabbing, dull, pressing. They are accompanied by fever, shortness of breath and other typical respiratory symptoms. Most often, pain under the left shoulder blade is felt by patients who develop:

• Pneumonia.The patient feels a 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. A deep cough appears with the release of mucopurulent sputum. Symptoms last up to 2-4 weeks.
• Pleurisy.With exudative pleurisy, a person feels pressure and popping 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, aggravated during movements.
• Tuberculosis.Tuberculosis infection lasts a long time, so low-intensity pain persists for several months. If the pain is localized in the scapula area, it is more likely that the pathological focus is localized in the posterior segments of the lung.
• Pulmonary infarction.The death of a section of the lung parenchyma is manifested by severe pain radiating under the left scapula, clinically resembling an angina attack. The patients' condition is complicated by hemoptysis or pulmonary hemorrhage, dysfunction of external respiration and arrhythmias.

Rare causes

• Neoplasms: osteoma and osteosarcoma, bone cyst, malignant skin tumors above the scapula (basal cell carcinoma, melanoma).
• Rare cardiovascular diseases: cardiac syndrome X, descending aortic aneurysm.
• Acute surgical diseases: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.

Diagnostics

Patients with pain under the left scapula are first referred for consultation to an orthopedic traumatologist. If there are no disorders of the musculoskeletal system, other specialists are involved in diagnostic research: neurologist, cardiologist, surgeon, etc. To establish the causes of pain, a full range of instrumental studies is prescribed, which includes:

• X-ray. An x-ray of the scapula in frontal and lateral projections allows you to exclude or confirm a traumatic injury. Spinal x-ray is indicated in cases of suspected osteochondrosis, scoliosis or spondylolisthesis. Simple x-ray of the chest cavity allows you 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 completed by classical or transesophageal echocardiography and cardiac electrophysiology.
• Ultrasound of the abdominal organs.A rapid, non-invasive method is used to detect common conditions that cause left shoulder blade pain. Ultrasound examination shows signs of stomach ulcer, inflammatory infiltration of the pancreas and enlargement of the spleen. To clarify the diagnosis of peptic ulcer, EGD is used.
• Additional methods. To clarify the nature and severity of bone changes, a 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 examination methods play an important role in making a diagnosis. A clinical blood test shows signs of inflammation or disruption of hematopoietic processes. Acute phase protein indicators and proteograms are informative in case of possible cardiac damage or an autoimmune process. Specific myocardial markers are evaluated for anginal pain.

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 test for the sensitivity of the isolated microorganisms to antibiotics.

Treatment

Help before diagnosis

Considering the variety of 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 advisable to reduce the load on the back muscles to eliminate simple fatigue and excessive strain, which can cause persistent painful symptoms. If the sensations are unbearable, analgesics are used and the patient is immediately admitted to hospital.

Conservative therapy

The treatment plan is selected only after a comprehensive diagnosis and determination of the etiological factors of pain under the left scapula. If the patient suffers from severe ailments, anti-inflammatory and muscle relaxant drugs are recommended, which quickly relieve painful sensations. For severe pain, therapeutic blocks and the administration of narcotic analgesics are effective. Taking into account the disease, a mode of physical activity is selected.

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 and anticoagulant agents, and antihypertensive drugs. Diseases of the bronchopulmonary system require the intervention of a pulmonologist and the use of antibiotics, expectorants and specific anti-tuberculosis drugs.

For gastrointestinal pathologies, an adequate diet is chosen and the therapy is integrated with enzymatic 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 postural disorders and other spinal problems, non-drug methods are actively used: traction therapy, therapeutic massage, physical therapy. Among the physiotherapeutic methods, balneotherapy (sulfide and radon baths), mud therapy and reflexology are popular. It is possible to increase the effectiveness of drug treatment by electrophoresis of drugs directly on the affected area.

Surgery

Surgical methods are indicated when conservative treatment is ineffective or in acute life-threatening pathologies, when the delay is dangerous for the patient's life and health. The second group of operations includes methods of stenting, angioplasty and bypass surgery for myocardial infarction, assistance from abdominal or thoracic surgeons for injuries, purulent processes and internal hemorrhages.

Planned surgical interventions are often prescribed in neurosurgery for severe radicular syndrome and intervertebral hernia. To eliminate pain associated with compression of nerve structures, microdiscectomy and laser vaporization of the disc are performed. In rare cases, spinal stabilization interventions are used (interbody fusion, application of a Halo device, transpedicular fixation).