Pain under left shoulder bladeobserved in musculoskeletal pathologies (osteochondrosis, myofascial syndrome, trauma), heart diseases (myocardial infarction, angina, 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 depending on the underlying syndrome: x-ray, 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. More rarely, radicular pain occurs in cases of spondylolisthesis and ankylosing spondylitis. Sharp 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. As a rule, the pain spreads from the shoulder blade 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 is manifested by pain in the region of the left shoulder blade, when the load is mainly on this side. The discomfort is felt by the patient as deep and moderately intense. At first, the pain is only felt during movement and exertion, 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 shoulder blade or soft tissue bruising in this area. If the integrity of the bone is preserved, the pain is moderate, the person can breathe deeply and move freely. In case of traumatic injury to bone structures, acute pain appears and mobility of the arm and shoulder girdle is often limited. When changing position or putting pressure on the injured area, sharp pain is felt.
Boils and carbuncles
Purulent inflammation of the skin surrounding the left shoulder blade is accompanied by severe pain, usually clearly localized. As the boil matures, "tightening" sensations appear, which intensify when the area of inflammation is palpated or rubbed with clothing. Once the tire is punctured and the necrotic core is removed, the pain diminishes. With a carbuncle, the pain is more intense and the patient's general condition often deteriorates.
Heart disease
Heart damage is a typical cause of pain under the left scapula, associated with the proximity of the anatomical location and the characteristics of the innervation. In this case, the symptoms are accompanied by chest pain 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:
- Myocardial infarction.Patients experience unbearable burning sensations that spread from the precordial region to the left arm and shoulder blade, and less often to the clavicle and neck. The illness comes on suddenly and is accompanied by a strong fear of death and a state of fainting.
- Stable angina.Episodes of constricting or pressing pain radiating to the subscapular area 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 to 15 minutes. After rest or taking nitrates, the pain disappears.
- Inflammatory heart diseases.Dull or stabbing pain in the chest, which radiates to the left shoulder blade and bothers the patient for several days, is typical for acute carditis (myocarditis, pericarditis). The person also complains of shortness of breath, increased body temperature and swelling of the lower limbs.
- Rheumatism.Radiating pain in the left half of the back associated with cardialgia is characteristic of the clinical picture of rheumatic carditis. The clinical picture is completed by arthralgia, ring-shaped skin erythema and rheumatic nodules. Symptoms are more often detected in children and adolescents.
Pancreatitis
Girdle pain that moves from the left hypochondrium to the subscapular region is observed with acute pancreatic inflammation. In addition to pain syndrome, patients worry about debilitating vomiting with bile and mucus impurities and tension in the abdominal muscles. Movement increases painful sensations, so the person tries to lie on their 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 feast, alcohol consumption. The pain is paroxysmal in nature, sometimes extending not only to the subscapularis, but also to the precordial region. Symptoms are associated with nausea, flatulence and steatorrhea.
Stomach ulcer
Pain under the left shoulder blade is a sign of a location of the defect on the rear wall of the stomach, closer to the back. Unpleasant sensations appear 20-50 minutes after the end of a meal. The earlier the symptoms appear, the higher the location of the ulcer. The discomfort becomes more severe when eating sour, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.
Spleen diseases
Pain and a feeling of fullness in the left subscapular region occur in cases of splenomegaly caused by infectious, autoimmune or myeloproliferative processes. With progressive enlargement of the organ, periodic discomfort develops 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 scapula.
A little less frequently, the cause of pain is surgical pathologies of the spleen: rupture, infarction, volvulus. In this case, there are cutting or shooting pains radiating under the shoulder blade, which are aggravated with the slightest movement. The patient therefore assumes a forced position: lying on the left side or on the back, knees folded against the 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 pathologies
Left-sided focal processes in the lungs often cause pain at the projection of the scapula. Discomfort increases with deep breathing, laughing and talking, as well as with a coughing fit. The pain is varied in nature: sharp, throbbing, 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 moderate dull pain, which has a clear localization in case of focal inflammation of the lungs or spreads throughout the scapular area in case of lobar pneumonia. A deep cough appears with the release of mucopurulent sputum. Symptoms last up to 2 to 4 weeks.
- Pleurisy.With exudative pleurisy, a person experiences pressure and bursting 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 region, worsened with movement.
- Tuberculosis.Tuberculosis infection lasts a long time, so low-grade pain persists for several months. If the pain is localized at the level of the scapula, the pathological focus is more likely to be localized in the posterior segments of the lung.
- Pulmonary infarction.The death of a section of the lung parenchyma is manifested by intense pain radiating under the left scapula, clinically resembling an attack of angina pectoris. The condition of patients is complicated by hemoptysis or pulmonary hemorrhage, dysfunction of external respiration and arrhythmias.
Rare causes
- Tumors: osteoma and osteosarcoma, bone cyst, malignant tumors of the skin above the scapula (basal cell carcinoma, melanoma).
- Rare cardiovascular pathologies: cardiac syndrome X, descending aortic aneurysm.
- Acute surgical illnesses: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
Diagnostic
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, including:
- X-ray. An x-ray of the scapula in frontal and lateral projections helps to exclude or confirm a traumatic injury. Radiological imaging of the spine is indicated in cases of suspected osteochondrosis, scoliosis or spondylolisthesis. A simple x-ray of the chest cavity allows one to suspect pulmonary or cardiac lesions.
- 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 package is completed by classic or transesophageal echocardiography and cardiac electrophysiology.
- Ultrasound of the abdominal organs.A quick, non-invasive method is used to detect common conditions causing 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 disease, EGD is used.
- Additional methods. To clarify the nature and severity of bone changes, a CT scan 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 a major role in establishing the diagnosis. A clinical blood test shows signs of inflammation or disruption of hematopoietic processes. Acute phase protein indicators and proteinograms are informative in case of possible cardiac damage or autoimmune processes. Specific myocardial markers are evaluated for anginal pain.
To diagnose gastrointestinal diseases, a coprogram 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 case of inflammatory processes in the lungs and pleura, bacteriological seeding of the biomaterial is necessary, followed by testing the isolated microorganisms for sensitivity to antibiotics.
Treatment
Help before diagnosis
Given the variety of causes of pain under the left shoulder blade, it is extremely difficult for a doctor to give recommendations until the underlying pathology is identified. During the examination, it is advisable to reduce the load on the back muscles in order to eliminate simple fatigue and overwork, which can cause persistent painful symptoms. If the sensations are unbearable, painkillers are used and the patient is immediately hospitalized.
Conservative therapy
The treatment plan is chosen only after a comprehensive diagnosis and determination of the etiological factors of pain under the left scapula. If the patient suffers from significant discomfort, anti-inflammatories and muscle relaxants are recommended, which quickly relieve painful sensations. In case of severe pain, therapeutic blockades and administration of narcotic analgesics are effective. Taking into account the disease, a mode of physical activity is selected.
Drug treatment 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 as well as antihypertensives. Diseases of the bronchopulmonary system require the participation of a pulmonologist and the use of antibiotics, expectorants and specific anti-tuberculosis drugs.
For gastrointestinal pathologies, a suitable 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 postural disorders and other problems of the spine, 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. It is possible to increase the effectiveness of drug treatment by electrophoresis of drugs directly to the affected area.
Surgery
Surgical methods are indicated when conservative treatment is ineffective or in acute life-threatening pathologies, 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 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. To eliminate pain associated with compression of nerve structures, microdiscectomy and laser vaporization of the disc are performed. In rare cases, spinal stabilization operations are used (interbody fusion, application of a Halo device, transpedicular fixation).