The shoulder blade is a three-dimensional triangular bone that connects the humerus and collarbone. It owes its name to the external resemblance to a well-known tool - a garden shovel. The joint socket of the shoulder blade and the humerus head form the shoulder joint, the most flexible joint in the human skeleton.
Pain under the right shoulder blade from behind from behind, in most cases, indicates the pathology of the articular elements of the shoulder, spine or paravertebral (paravertebral) structures. Other possible causes include damage to internal organs - bronchi, lungs, kidneys, and gallbladder. Persistent pain syndrome in the shoulder blade area almost always indicates a serious problem that requires medical and sometimes surgical treatment.
Muscle strain and inflammation
A large number of muscles are attached to the shoulder blade: subscapularis, coracohumeral, small and large lozenge, deltoid muscle. Most often, there is pain under the right shoulder blade because a stretch has occurred or an inflammatory process is developing.
Muscle stretching can put a lot of strain on the back, lifting and carrying weights, causing sudden movements and prolonged uncomfortable postures. However, as practice shows, in more than half of the cases, excessive physical exertion by an unprepared person and improper movement are the cause.
The symptoms of a stretch are as follows:
- sharp pain of varying intensity;
- increased pain when turning and tilting the body;
- Relief at rest;
- Swelling and bruising (which can be seriously damaged).
The basic principle of sprain treatment is complete rest and the elimination of stress. Immediately after the injury, you must apply ice or a cold compress to the painful area, or take an anesthetic pill if necessary.
With inflammation of the muscles - myositis - aching pain worries that increase with pressure and movement. Sometimes there is slight swelling and redness. The general condition often deteriorates: the body temperature rises, the head hurts and small painful seals can be felt in the muscles.
The causes of myositis are diverse, but most often it develops against the background of acute respiratory viral infections, flu or tonsillitis. It should be noted that muscles in the chest area become inflamed relatively rarely, since myositis is mainly localized in the upper or lower back.
One of the variants is ossifying myositis or fibrodysplasia - an extremely rare form of the disease. This congenital disorder of osteogenesis (bone formation) develops rapidly and manifests itself in childhood.
Fibrodysplasia is the formation of ossified points in the muscle structure that gradually enlarge and injure the surrounding tissue. The process of ossification can be localized almost anywhere - near the spine, on the limbs or in the pelvic area.
Reference:The ossifying myositis is incurable and does not even lend itself to surgical treatment. After removing the ossificates, they are formed again.
Myofascial Syndrome
Muscle pain in the back is most common after a headache. More than 40% of people suffer from chronic pain syndrome, most of them are women.
Myofascial syndrome is a progressive disease that is characterized by the formation of trigger points (pain points) in the muscles. The diameter of each point varies from 1 to 3 mm, the accumulation of points can create a painful area of 1 cm2. These points are formed under the influence of trauma and muscle strain.
A number of factors can provoke this process:
- Skeletal abnormalities - scoliosis (curvature of the spine to the left or right), pelvic asymmetry, shortening of one of the limbs, flat feet;
- Back injuries;
- Spinal diseases - osteochondrosis, spondyloarthrosis, as well as hernia and protrusion;
- long-term use of drugs - β-blockers, cardiac glycosides, calcium antagonists, antiarrhythmics, anesthetics;
- Damage to connective tissue in autoimmune diseases - rheumatism, lupus erythematosus.
Cholelithiasis
In diseases of the gallbladder, the pain often radiates to the right shoulder blade. This is due to a spasm of the smooth muscles when the walls of the bladder are irritated by the concrements (stones) formed. A bile colic attack usually occurs suddenly and focuses on the right side under the ribs.
The pain syndrome has an acute, cutting character and in most cases occurs after consumption of fatty, fried, spicy foods and alcoholic beverages. The cause of a seizure can be intense physical exertion, nervous stress or prolonged inclination.
When the bile duct is blocked, the pain is felt as dull and astringent. A concomitant symptom is heaviness in the lower abdomen on the right side and nausea, which turns into vomiting. An increase in body temperature is possible, sometimes to high values. With blockage of the main bile duct and obstruction of the Oddi sphincter muscle, jaundice develops and the feces become discolored.
Treatment of gallstone disease can be conservative and surgical. In the absence of complications, specific therapy is not carried out. Individual stones can be removed using shock wave lithotripsy.
Subphrenic abscess
Back pain in the area of the shoulder blades can be explained by the formation of a subphrenic abscess - an abscess localized under the dome of the diaphragm. Most often, it occurs after abdominal surgery when peritonitis develops. The pathogen can be staphylococci, streptococci or E. coli.
Infection enters the body after partial or complete removal of the stomach, resection of the pancreas, suturing of the perforated ulcer, removal of the spleen. The cause can be inflammatory pathology of the internal organs, open or closed abdominal trauma, as well as severe lung lesions, osteomyelitis of the vertebrae and rib bones.
General symptoms appear first - weakness, sweating, and fever. The increased body temperature can be kept constant or increase periodically. Then it starts to hurt in the upper third of the abdomen and lower chest from the affected side. Pain syndrome of varying intensity often radiates under the scapula, shoulder, or collarbone.
Characteristic signs of an abscess are shortness of breath, dry cough, hiccups, and increased pain when moving, taking deep breaths, coughing, and sneezing. The patient breathes frequently and shallowly, tries to assume a semi-sitting position.
Treatment of the subphrenic abscess consists of surgical opening and drainage of the abscess, after which antibacterial, anti-intoxication, anti-inflammatory and restorative therapy is carried out.
Reference:If the operation is not carried out on time, the abscess breaks into the abdominal and pleural cavity, which almost guarantees a fatal outcome.
pleurisy
Pain near the shoulder blade can cause bronchopulmonary disease - pneumonia or bronchitis, complicated by pleurisy. In this case, it can hurt both below and above the shoulder blade. However, the main source of pain is the chest and upper abdomen.
Pleurisy is always a complication of another disease, including malignant neoplasms. It can be caused by a bacterial, viral, or fungal infection, trauma, and breast surgery.
In some cases, pleurisy develops against the background of autoimmune diseases - scleroderma, rheumatoid arthritis, lupus erythematosus, vasculitis, as well as pulmonary thromboembolism, myocardial infarction, pancreatitis.
A malignant tumor is diagnosed in 25% of patients with pleurisy - mesothelioma or metastases from other organs (mammary gland, ovaries). Metastatic pleurisy usually has mild symptoms and is often only manifested by the pain behind the breastbone.
If a large amount of exudate accumulates, puncture must be performed for evacuation or drainage. Depending on why pleurisy developed, specific treatment will be prescribed. It can contain antibiotics, steroids, anti-inflammatory drugs. The form of tuberculosis is treated with special drugs.
Urolithiasis disease
The formation of stones in the urinary system occurs most often in middle-aged people - from 25 to 50 years. The disease progresses in different ways: some have symptoms that are limited to a single unpleasant episode, others complain of regular exacerbations. In some cases, urolithiasis has a chronic, protracted course.
The main symptom is renal colic when the ureter is blocked. The localization of the pain syndrome depends on the location of the stone, and the intensity depends on its size. Right shoulder blade pain occurs when the right kidney is affected. When the stone is lower, the lower back or abdomen hurts.
Typical symptoms of urolithiasis are more frequent urge and burning sensation when urinating, fever and nausea.
The method of treatment can be conservative and surgical. Most often, surgery is required, the indications for its implementation are:
- big stones;
- the development of kidney failure;
- Localization of tartar in the kidney, renal pelvis or ureter;
- purulent pyelonephritis.
The operation can be open or endoscopic. Shock wave lithotripsy is the gentlest method to reduce the proportion of postoperative complications.
During operation, stones are crushed with the help of a reflector that emits electro-hydraulic waves. After crushing, stone particles and sand are excreted in the urine. Sometimes their movement along the ureter causes renal colic, which can be easily stopped with medication.
Reference:any operation is no guarantee that there will be no relapse. Therefore, complex therapy is necessarily carried out, which can last for several years.
Intercostal neuralgia
Intercostal neuralgia (thoracic pain) is characterized by severe symptoms and most often manifests itself as acute, stabbing pain in the ribs both in front and behind. It can occur intermittently or be a constant disturbance. The pain syndrome is painful, burning or dull, but always difficult to bear.
A characteristic sign of neuralgia is a sharp increase in pain when inhaling, changing posture or sneezing. Often during a painful attack, the muscles twitch, sweating increases, the skin turns red or, conversely, pale. Numbness occurs at the site of damage to the nerve endings.
The immediate cause of the pathology is pinching of the nerve roots, which is favored by various factors and diseases:
- Osteochondrosis;
- Spondylitis;
- Ankylosing spondylitis;
- primary and metastatic tumors;
- disruption of the stomach (gastritis);
- age-related changes in blood vessels;
- Metabolic disease;
- Chest trauma;
- Flu, SARS;
- Hypothermia and drafts;
- prolonged or severe nervous stress;
- high level of physical activity;
- unsuccessful body rotation, prolonged stay in a static position.
Reference:Intercostal neuralgia is characterized by pain that lasts from a few seconds to three minutes. During this time, the patient tries not to breathe or move so as not to aggravate the pain.
The main direction of treatment is pain syndrome relief, for which anti-inflammatory nonsteroidal drugs (NSAIDs) are prescribed. If the pain is severe, therapeutic blockades are carried out with anesthetics and steroids. Sedatives are used to raise the threshold of CNS excitability.
Specific therapy will depend on the origin of the neuralgia and may include antivirals, antihistamines, and muscle relaxants.
Neoplasms
Bone tumors in the shoulder blade are very rare and can be both benign and malignant. The former include osteoma and chondroma, the latter - chondrosarcoma and Ewing sarcoma. Osteoma is characterized by slow growth and a favorable course. Children and adolescents between the ages of 5 and 20 are particularly affected.
Osteomas can grow asymptomatically and manifest only when the surrounding structures - nerve roots and blood vessels - are compressed. Treatment is surgical only, there are practically no relapses.
Chondroma is a benign tumor that arises from cartilage tissue. It should be noted that if the chondroma is localized in the shoulder blade, then the tumor often degenerates into a malignant one. Due to the high risk of malignancy, such formations are radically removed.
Chondrosarcoma, like chondroma, is formed by cartilage tissue, but it is malignant and widespread. Its growth is accompanied by increasing pain and swelling in the affected area.
Chondrosarcoma occurs in people of all ages, including children, but the largest percentage is in middle age - from 40 to 60 years. Most of the time, men suffer. The main method of treatment is removal of the tumor; if the surgery cannot be performed, chemotherapy and radiation therapy are performed.
Ewing's sarcoma is one of the most aggressive malignant tumors that is prone to early metastasis. It affects children and adolescents, manifests itself in severe symptoms - pain, swelling and redness.
Since the tumor is very aggressive, both surgical and therapeutic treatment is carried out. Chemotherapy and radiation therapy are performed both before and after surgery, using high doses and multiple drugs. The prognosis of the disease is partially unfavorable.
Pain under the right shoulder blade can be a completely harmless symptom or indicate a serious illness. To get rid of pain and prevent possible complications, you need specialist advice and examination. Based on the results, the doctor will prescribe treatment and give the necessary recommendations. Bless you!