Pain in the shoulder blade and below: what may indicate discomfort

21 June 2022

Pain in the shoulder blade and below can occur with nerve damage, diseases of the spine, shoulder girdle, or somatic pathologies. The cause can be determined by clinical signs, conditions for the manifestation of the syndrome and data of the anamnesis.

Pain in the scapular region can be felt during inhalation, felt in half of the body and or throughout the arm. In some cases, such symptoms are the "first bell" of the exacerbation period, which can be prevented after the provoking factor has been established.

Causes and localization

Pain under the shoulder blade usually appears during movement: it is preceded by an awkward turn, long standing with a bent back. Indicates local damage that appears for various reasons.

Pathologies with one-sided lesions, in which it hurts only on the right or left under the scapula, are few - usually the severity of the symptom is individual. This is due to the symmetrical arrangement of the nerve roots extending from the spinal cord.

Injuries

If it hurts under the right and left shoulder blades, it could be the result of damage to the bones and muscle structure. Symptoms do not have a rigid localization, the severity depends on the traumatic factor. The clinic is usually acute, begins abruptly and acquires a chronic course.

The causes of traumatic pain under the left or right shoulder blade are as follows:

Bruises - in these cases, the pain is superficial, most often the muscles are damaged. Usually the back muscles under the shoulder blades and under the shoulder blades hurt, local swelling and inflammation develop. After 2-3 weeks, the symptoms disappear.
Cracks and fractures are more serious injuries, the pain is concentrated in the shoulder blade itself. At the slightest movement, it intensifies, the patient cannot move his arm or bend.
Subluxation and displacement of the vertebrae: This leads to joint pain in the shoulder blades and below, sometimes the bone structures compress the nerve roots.

The lesions are characterized by severe pain under the right or left shoulder blade, which appears spontaneously. A creak may be present during movements and swelling often appears.

Osteochondrosis

If the disease affects the thoracic spine, the patient has back pain near the shoulder blades and below. This is due to pinching of the nerves or spinal cord due to deformation of the joint disc. Pathology develops gradually, and as the distance between the vertebrae decreases, the pathology clinic becomes worse.

The localization of pain depends on the affected area:

If osteochondrosis destroys the articular discs of the thoracic region 2 to 6, pain is felt in the shoulder blade. It usually radiates to the neck and arm. When the vessels are squeezed, dizziness appears, intracranial pressure can increase.
When the joints of 6-12 segments are affected, the pain radiates under the left or right shoulder blade, spreads lower, to the corresponding half of the body and to the lower back.

The spinal roots of the thoracic region give rise to plexuses that innervate the arms and torso. Therefore, when they are squeezed, the pain spreads along their course.

With osteochondrosis, the discomfort is one-sided: it hurts the shoulder blade on the right or left side and below, depending on the inclination of the spine.

Scoliosis

This is a curvature of the spine in the transverse direction due to overloading of the muscles that support posture. This leads to pinching of the roots and spinal cord, the appearance of pain under the shoulder blade on the right or left. The pathology is usually accompanied by:

Respiratory failure - a one-sided tilt of the spine deforms the chest, which affects the functioning of the lungs, one of which is compressed, and the second takes on the lost function.
Violation of the work of the heart - the frequency of contractions and changes in the pulse, shortness of breath and paleness of the skin appear.
The appearance of a visible deformation of the chest is the main cause of pain under the right or left shoulder blade. The vertebrae, together with the ribs, are displaced laterally, as a result of which, on the side of the curvature, the bone structures are displaced downwards and damage the spinal cord with its branches.

If the spinal cord is compressed during scoliosis, the back usually hurts between the shoulder blades and below, the focus is strictly limited. If the muscle spasms join, the symptom spreads to nearby structures.

Kyphosis

It is characterized by a backward bending of the spine, a forward displacement of the shoulder girdle, and a curve gradually appears. There is pain above the shoulder blade - usually bilateral, it gives to the arm and neck. The following mechanisms are involved in its formation:

Neurogenic - due to the curvature, the distances between the vertebral bodies in the anterior sections decrease, this causes pinching of the branches of the spinal cord. There is aching pain in the right and left shoulder blades, which can radiate to the collarbone, neck and shoulder.
Muscular: The deflection of the spine leads to an overload of the muscles of the collar area, which can have painfully spasms in the area of the shoulder blades and below.

As a result of kyphosis, the vertebral artery is compressed, the cerebral circulation is disturbed. The work of the internal organs gradually worsens.

Spondyloarthrosis

If the right or left shoulder blade hurts, one of the reasons may be spondyloarthrosis - damage to the joint facets and intervertebral discs. It is accompanied by a loss of mobility, stiffness appears, more pronounced in the morning.

The clinical picture changes as the disease progresses: >

Destruction of cartilage: with a lack of blood circulation, the integrity of the connective tissue is violated, the joint disc becomes fragile, more damaged and recovers more slowly. At this stage, strong physical exertion leads to microtrauma, pain occurs, which radiates to the area of the shoulder blades and below.
Deformation of the articular disc - seals appear that prevent mobility. This causes a new destruction, which slows down the regeneration processes, the patient feels pain in the back and shoulder blades.
The appearance of bone growths is characteristic of the advanced stage of the disease. Cancers damage joints, muscles, blood vessels and nerves.

With spondylarthrosis, the back can hurt between the shoulder blades or below - an attack is usually preceded by physical activity. At rest, the symptoms disappear, because the bony growths do not damage the surrounding tissues.

Protrusion and hernia

In these conditions, acute pain under the left and right shoulder blades, which appears due to compression of the spinal cord or its roots, worries. As a result of pinching, the sensitivity along the nerve fibers is disturbed.

The localization of symptoms is as follows:

Pain in the shoulder blades and above - protrusion or hernia in the cervicothoracic region or when 1-3 thoracic segments are affected. The symptom intensifies when you try to tilt your head, turning it to the side.
Pain in the interscapular region - in this case, the middle sections may be affected, 3 to 6. The discomfort increases when both hands are moved to the side, inhaled deeply or turned.
Severe pain under the right and left shoulder blades - joint discs 6 to 12 are affected, the lower back can be involved in the pathology. In this case, there is a risk of developing a hernia, since this section of the spine is loaded more than the previous ones.

Unlike spondylarthrosis, hernia and protrusion pain do not go away for a long time at rest. This is due to the constant compression of the nerve, which is aggravated by muscle spasm.

Radiculitis

This is a pinching of the lumbar roots, which are gathered in a powerful sciatic nerve. If its upper sections are affected, the patient feels pain under the shoulder blade and below, it is bilateral, aggravated by bending and sudden movements.

As the disease progresses, additional symptoms may appear: >

There are back pains that radiate to the lower limb - severe shooting pain feels like an electric shock along the course of the nerve.
Burning pains in the back, lumbar region or under the shoulder blades indicate prolonged pinching of the spinal roots in the lumbar region.
Cramps and loss of sensation usually occur in the lumbar region, buttocks, sometimes there is numbness along the nerve fibers on the thigh, lower leg and foot.

Shoulder-scapular periarthrosis

This condition is understood as inflammation of the shoulder joint and surrounding tissues, stiffness occurs, which disappears only after rewarming.

The pain is concentrated in the region of the right or left shoulder blade and below, depending on the development of hemispheric motor skills (right or left-handed). First, it appears after exercise, and then at rest. Along the way, additional symptoms appear:

headache;
numbness of the hand;
violation of the mobility of the spine.

With humeroscapular periarthrosis, clinical manifestations increase when the arm is raised - it hurts in the region of the right or left shoulder, scapula. Gradually, the range of motion decreases, stiffness progresses.

Neuralgia

The next cause of pain under the right or left shoulder blade is inflammation of the nerves in this area. The disease is caused by hypothermia, drafts. Most often affected:

Suprascapular and supraspinal nerves - there is pain in the right or left shoulder blade from the back, concentrated mainly in the collarbone. Sometimes the discomfort spreads to the shoulder, which indicates the defeat of the skin branches of this area.
Subscapularis and infraspinatus nerves - in this case, it hurts to the right or left under the scapula, depending on the side of the lesion. If the homonymous muscles are involved, the clinical manifestations are aggravated when the arms are lowered, abducted behind the back.
Intercostal nerves - usually 1-4 pairs. These branches go along the lower edge of the rib, pain manifests itself not only in the area of the shoulder blades and below, but also on the sides of the chest, sometimes in the anterior sections.

Symmetry is not typical of neuralgia: if the left half of the body was exposed to drafts, pain in the neck, chest and shoulder blade is noted on this side.

Heart disease

The branches of the parasympathetic trunk, which is connected to the spinal cord and its roots, go to the heart. This is why heart disease can cause pain in the shoulder blade and below. A mild form of myocardial infarction is usually latent. It can be accompanied by the following symptoms:

Dull or burning pain felt behind the breastbone or under the left shoulder blade: can last for hours, increase when walking, but go away a little at rest.
Shortness of breath: accompanies pain, can manifest itself within a few days.
Tachycardia - increased heart rate, rhythm disturbances sometimes occur.
Other symptoms are increased blood pressure, dizziness, nausea and vomiting.

Problems with the gastrointestinal tract

Similar to the previous mechanism, the pain spreads along the nerve fibers. Clinical signs can be bilateral, but in most cases there is a certain pattern in which symptoms appear based on the location of the internal organs.

Pain under the left shoulder blade from behind from the back occurs with the following diseases:

pancreatitis;
gastritis;
stomach ulcer.

Usually, with these diseases, patients complain of dyspeptic disorders, nausea and vomiting. If internal bleeding occurs, pale skin, dark color of stool, decreased blood pressure and weakness are noted.

Pain under the right shoulder blade from behind from the back accompanies:

cholelithiasis;
hepatitis;
cirrhosis of the liver;
ulcerative lesion of the duodenum.

Other reasons

In addition to these factors, pain under the shoulder blades can provoke:

Uncomfortable mattress - if it breaks down and you sleep on the right side, in the morning you may feel pain under the left shoulder blade from behind from the back, as the curved spine pinches the spinal roots.
Pleurisy - pain in the scapular region occurs when breathing due to the friction of the sheets against each other, reaches a peak with a deep breath.
Poliomyelitis - the pathology is accompanied by neurological symptoms, back pain often appears.
Intoxication: Severe poisoning or a cold can manifest as body aches, chills, and fever.
VVD - vegetovascular dystonia is accompanied by a change in pressure, interruptions in the work of the heart and shortness of breath, and sometimes discomfort in the back.
Kidney disease: such pathologies are characterized by aching or stabbing pain under the right shoulder blade, a change in diuresis and urine color, and general symptoms.
Subdiaphragmatic abscess - if suppuration is noted in the upper plane of the abdominal cavity, pain under the shoulder blades, fever and symptoms of intoxication will be felt during inhalation.
Mental disorders - in some cases, pain in the shoulder blades and below can be the result of such ailments. The exact mechanism of occurrence has not been studied.

The nature of the pain

Pain in the area of the shoulder blades and below can be different, by its nature it is possible to assume a specific group of pathologies, sometimes a provoking factor can be established:

For pinched nerves, low back pain is characteristic - a sharp stabbing pain that appears with a sharp rotation of the body, lifting the arm. This is the main difference from cholelithiasis, in which the symptom is not curled by the movements.
Aching, throbbing or burning pain indicates a pathology of the internal organs. The latter option occurs when the roots of the spinal cord are squeezed, but increases with movement and can turn into seams.
Severe constricting pain in the area of the shoulder blades and below is characteristic of a hernia. Sometimes it is preceded by low back pain, numbness of the limbs.
Cutting pain of varying intensity is characteristic of neuralgia, perforation often accompanies inflammation of the joints.

Which doctor treats shoulder blade pain?

If you experience pain in the shoulder blade and below, you need to make an appointment with a neurologist. If there are no pinched nerves, the specialist will redirect you to a consultation with an orthopedist, cardiologist, gastroenterologist or urologist, depending on the suspected disease

Diagnostics

To identify the cause of discomfort in the shoulder blade area and below, a laboratory and instrumental examination is performed:

X-ray or CT: Using these methods, osteochondrosis, curvature of the spine and the consequences of injuries can be detected.
Magnetic resonance >- the spine, shoulder joint or internal organs are examined, depending on the suspected pathology.
ECG: Helps identify heart disease.
Blood and urine tests are informative for some somatic pathologies, inflammation of muscles and joints.
Ultrasound - is prescribed for somatic diseases, if it is impossible to undergo an MRI.

Usually, pain under the shoulder blades occurs due to neurology. Therefore, CT and MRI are considered the "gold standard" in the diagnostic protocol.

General principles of treatment

The main task is to eliminate the symptoms and the provoking factor. First, the patient's well-being is stabilized, then the underlying pathology is treated.

The therapeutic program includes:

Medications - Pain relievers are usually prescribed to relieve pain and inflammation. Then the funds are prescribed depending on the underlying disease: antibiotics, gastroprotectors, diuretics.
Physiotherapy - strengthens the spine, treats somatic diseases. Medicinal electrophoresis is used in the area of the shoulder blades, warming procedures, SWT.
Massage - Warming up is performed with damage to the spine. From such procedures, the muscles above and below the shoulder blades relax, posture improves. In this case, you need the help of a chiropractor or osteopath.
Gymnastics - is performed after the elimination of pain, the program is compiled, depending on the disease suffered by a physiotherapist, a rehabilitation specialist.

Prevention

After successful treatment, patients are advised to follow a preventive program that prevents recurrence of the disease:

look at your posture;
choose a mattress of moderate hardness and an orthopedic pillow;
twice a week, massage in the area of the shoulder blades and below;
follow a low-calorie diet for obesity;
get rid of bad habits;
conduct prophylaxis of somatic pathology (if present in the anamnesis);
visit a doctor every six months.

Pain in the shoulder blades and below can be neurological or somatic in nature. When the nerves are damaged, the symptoms are acute and sudden, appearing spontaneously.

Pathologies of internal organs and joints are characterized by gradual and prolonged pain, the clinic is always accompanied by additional symptoms. In the initial stages, analgesics are prescribed, after diagnosis, the program is supplemented with etiological therapy and strengthening procedures.