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 ulcers). Rare causes of the symptom include damage to the spleen, ulcers, and skin tumors. Diagnostic methods are selected based 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. Less commonly, radicular pain occurs in spondylolisthesis and ankylosing spondylitis. Acute pain in the projection of the left scapula is observed when 3-6 thoracic roots are involved in the process; Discomfort directly under the scapula indicates the localization of damage in the 7-8th vertebrae. Typically, the pain spreads from the scapula to the lateral surface of the chest and 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 region of the scapula on the left, when the load is predominantly on this side. The discomfort is felt by the patient as deep and moderately intense. At first, the pain is felt only during movements and efforts, but over time it becomes constant. Sometimes the radiating pain appears in the left forearm or hand.
Injuries
Severe pain develops after a crack or fracture of the scapula or hematoma of the soft tissues in that area. If the integrity of the bone is preserved, the pain is moderate, the person can breathe deeply and move freely. When traumatic damage to bony structures occurs, sharp pain occurs and mobility of the arm and shoulder girdle is often limited. When changing position or pressing on the injured area, sharp pain is felt.
Boils and carbuncles
Purulent inflammation of the skin around the left shoulder blade is accompanied by severe pain, which, as a rule, is very localized. As the boil matures, "pulling" sensations occur, which intensify when the inflamed area is palpated or rubbed with clothing. After the tire ruptures and the necrotic core comes out, the pain subsides. In anthrax, the pain is more intense and the patient's general condition usually worsens.
Heart diseases
Cardiac injury 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 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 as:
- Myocardial infarction.Patients experience unbearable burning sensations that spread from the precordial region to the left arm and shoulder blade and, less frequently, to the clavicle and neck region. The condition occurs suddenly and is accompanied by a strong fear of death and a fainting state.
- Stable angina.Episodes of compression or pressure pain radiating to the subscapularis area are specific to attacks of ischemic heart disease. Unpleasant symptoms are caused by physical activity or emotional stress and last an average of 10 to 15 minutes. After resting or taking nitrates, the pain disappears.
- Inflammatory heart diseases.Dull or sharp pain in the chest, which radiates to the left shoulder blade and bothers 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, annular erythema on the skin and rheumatic nodules. Symptoms are most frequently detected in children and adolescents.
Pancreatitis
Waist pain moving from the left hypochondrium to the subscapular region is seen in acute pancreatic inflammation. In addition to the pain syndrome, patients are worried 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 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 large 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 the location of the defect on the back wall of the stomach, closer to the back. Unpleasant sensations appear 20-50 minutes after finishing a meal. The earlier the symptoms occur, the larger the location of the ulcer. Discomfort becomes more severe when eating acidic, 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 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 often, the cause of pain is surgical pathologies of the spleen: rupture, heart attack, volvulus. In this case, cutting or throbbing pains occur that radiate under the scapula, which are aggravated by the slightest movement. Therefore, the patient assumes a forced position: lying on the left side or on the back with the knees bent 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 in the projection of the scapula. The discomfort increases with deep breathing, laughing and talking, and a coughing fit. The pain is of a varied nature: sharp, piercing, 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 region in case of lobar pneumonia. A deep cough appears with the release of mucopurulent sputum. Symptoms last 2 to 4 weeks.
- Pleurisy.In exudative pleurisy, a person feels pressure and rupture 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 during movement.
- Tuberculosis.Tuberculous infection lasts a long time, so low-intensity pain persists for several months. If the pain is localized in the region of the scapula, the pathological focus is most likely located in the posterior segments of the lung.
- Pulmonary infarction.The death of a section of the lung parenchyma is manifested by intense pain that radiates under the left shoulder blade, clinically resembling an angina attack. The condition of patients is complicated by hemoptysis or pulmonary hemorrhage, dysfunction of external breathing and arrhythmias.
Rare causes
- Neoplasms: osteoma and osteosarcoma, bone cyst, malignant tumors of the skin above the scapula (basal cell carcinoma, melanoma).
- Rare cardiovascular pathologies: cardiac syndrome X, aneurysm of the descending aorta.
- Acute surgical illnesses: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
Diagnosis
Patients with pain under the left shoulder blade are first referred for consultation with an orthopedic traumatologist. If there are no disorders of the musculoskeletal system, other specialists are involved in the diagnostic search: neurologist, cardiologist, surgeon, etc. To establish the causes of pain, a full range of instrumental studies is prescribed, which includes:
- Radiography. Radiography of the scapula in frontal and lateral projections allows us to exclude or confirm a traumatic injury. Radiation imaging of the spine is indicated for suspected osteochondrosis, scoliosis, or spondylolisthesis. A simple x-ray 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 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 shows signs of a stomach ulcer, inflammatory infiltration of the pancreas and an enlarged spleen. To clarify the diagnosis of peptic ulcer disease, EGD is used.
- Additional Methods. To clarify the nature and severity of bone changes, a computed tomography or magnetic resonance imaging scan 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 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 heart damage or autoimmune process. Specific myocardial markers are assessed 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 the case of inflammatory processes of the lungs and pleura, bacteriological sowing of the biomaterial is necessary, followed by a sensitivity test of the isolated microorganisms 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 to eliminate simple fatigue and overexertion, which can cause persistent pain symptoms. If the sensations are unbearable, analgesics are used and the patient is immediately hospitalized.
Conservative therapy
The treatment plan is selected only after complete diagnosis and determination of the etiological factors of pain under the left shoulder blade. If the patient feels intense discomfort, anti-inflammatories and muscle relaxants are recommended, which quickly relieve painful sensations. For severe pain, therapeutic blocks and 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 caused by heart damage, the cardiologist prescribes antianginal and antiarrhythmic, antiplatelet and anticoagulant, and antihypertensive medications. Diseases of the bronchopulmonary system require the involvement of a pulmonologist and the use of antibiotics, expectorants and specific drugs against tuberculosis.
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 postural 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. It is possible to increase the effectiveness of drug treatment by electrophoresing drugs directly into 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 patient's life and health. The second group of operations includes stent implantation methods, angioplasty and bypass surgery for myocardial infarction, assistance from 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 disc vaporization are performed. In rare cases, they resort to spinal stabilizing operations (interbody fusion, application of a Halo device, transpedicular fixation).