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 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 the damage in the 7th-8th vertebrae. Typically, 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 area 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, pain is experienced only during movement and exertion, but over time it becomes constant. Sometimes radiating pain appears in the forearm or left hand.
Injuries
Intense pain develops after a crack or fracture of the scapula or bruise of the soft tissue over 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 changing position or pressing on the injured area, sharp pain is felt.
Boils and carbuncles
Purulent inflammation of the skin surrounding the left shoulder blade 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.
Cardiac diseases
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 pain in the chest 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 area. The condition occurs suddenly and is accompanied by a strong fear of death and a faint state.
- Stable angina.Episodes of squeezing or pressing pain radiating to the subscapular area are specific to attacks of ischemic heart disease. 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 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 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-shaped erythema on the skin, 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 the pain syndrome, patients are worried about debilitating vomiting with impurities of bile and mucus, and tension in the abdominal muscles. Movement increases the 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 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 localization of the defect on the back wall of the stomach, closer to the back. Unpleasant sensations appear within 20-50 minutes after finishing a meal. The earlier symptoms occur, 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 area occurs with splenomegaly caused by infectious, autoimmune or myeloproliferative processes. With gradual 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 shoulder blade.
Somewhat less frequently, the cause of pain is surgical pathologies of the spleen: rupture, infarction, volvulus. In this case, there are cutting or throbbing pains radiating under the scapula, which are aggravated by the slightest movement. Therefore, the patient takes a forced position: lying on his left side or on his back with his knees tucked 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 pathologies
Left-sided focal processes in the lungs often cause pain in the projection of the scapula. Discomfort increases with deep breaths, laughing and talking, and a coughing attack. The pain has a varied nature: sharp, 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 experienced 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 throughout the 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 experiences pressure and bursting under the scapula 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 area of the scapula, the pathological focus is more likely to be located in the posterior segments of the lung.
- Pulmonary infarction.The death of a section of the pulmonary parenchyma is manifested by severe pain that radiates under the left shoulder blade, 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 tumors of the skin above the scapula (basal cell carcinoma, melanoma).
- Rare cardiovascular pathologies: cardiac syndrome X, aneurysm of the descending aorta.
- Acute surgical diseases: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
Diagnostics
Patients with pain under the left shoulder blade are first referred for consultation to 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.An X-ray of the scapula in frontal and lateral projections allows one to exclude or confirm traumatic injury. Radiation imaging of the spine is indicated for suspected osteochondrosis, scoliosis, or spondylolisthesis. Plain radiography of the chest cavity allows one 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 the abdominal organs.A quick and non-invasive method is used to detect common conditions causing pain in the left shoulder blade. Ultrasound examination shows signs of a stomach ulcer, inflammatory infiltration of the pancreas, and enlarged 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 are performed. If there are difficulties in diagnosing abdominal pathology, diagnostic laparoscopy is recommended.
Laboratory examination methods play a major role in making a diagnosis. A clinical blood test shows signs of inflammation or disruption of hematopoietic processes. Indicators of acute phase proteins and proteinograms are informative in case of possible heart damage or an autoimmune process. Specific myocardial markers are assessed 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 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 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 a complete diagnosis and determination of the etiological factors of pain under the left shoulder blade. If the patient suffers from severe discomfort, anti-inflammatory drugs and muscle relaxants are recommended, which quickly relieve painful sensations. For severe pain, therapeutic blockades 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 agents and anticoagulants, and antihypertensive drugs. 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 medications. 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 with 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 to the life and health of the patient. The second group of operations includes methods of stenting, angioplasty and bypass surgery for myocardial infarction, the 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, stabilizing operations on the spine are resorted to (interbody fusion, application of a Halo device, transpedicular fixation).