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

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, the conditions for the manifestation of the syndrome, and anamnesis data.

Pain in the scapular region can be felt during inhalation, felt in half of the body and or throughout the arm. In certain 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. It signals local damage that appears for various reasons.

Pathologies with unilateral 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, this may be the result of damage to the bones and muscle frame. Symptoms do not have a strict 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 such cases, the pain is superficial, most often the muscles are damaged. Usually the back muscles under the shoulder blades and below hurt, swelling and local inflammation develop. After 2-3 weeks, the symptoms go away.
Cracks and fractures are more serious injuries, the pain is concentrated in the scapula itself. At the slightest movement, it intensifies, the patient cannot move his arm or bend over.
Subluxation and displacement of the vertebrae - this leads to joint pain at the level of the shoulder blades and below, sometimes the bone structures compress the nerve roots.

Injuries are characterized by severe pain under the right or left shoulder blade, which appears spontaneously. During movements, a crunch may be present, 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 articular disc. Pathology develops gradually, and as the distance between the vertebrae decreases, the pathology clinic is aggravated.

Localization of pain depends on the affected area:

If osteochondrosis destroys the articular discs of the thoracic region from 2 to 6, pain is felt in the scapula. It usually radiates to the neck and arm. When the vessels are squeezed, dizziness appears, intracranial pressure may 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 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 in the shoulder blade on the right or left side and below, depending on the skew of the spine.

Scoliosis

This is a curvature of the spinal column in the transverse direction due to overstrain 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. Pathology is usually accompanied by:

Respiratory failure - a unilateral skew of the spine deforms the chest, which affects the functioning of the lungs, one of which is compressed, and the second takes over the lost function.
Violation of the work of the heart - the frequency of contractions and pulse changes, shortness of breath and pallor 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 downward 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 muscle spasms join, the symptom spreads to neighboring structures.

Kyphosis

It is characterized by a back bending of the spine, a forward displacement of the shoulder girdle, and a stoop gradually appears. There is pain over the shoulder blade - usually bilateral, 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 provokes 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 spinal column leads to an overstrain of the muscles of the collar zone, which can painfully spasm in the area of the shoulder blades and below.

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

Spondylarthrosis

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

The clinical picture changes as the pathology progresses: >

Destruction of cartilage - with a lack of blood circulation, the integrity of the connective tissue is violated, the articular 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 impede mobility. This provokes 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. Neoplasms injure the joints, muscles, blood vessels and nerves.

With spondylarthrosis, the back may hurt between the shoulder blades or below - an attack is usually preceded by physical activity. At rest, the symptoms subside, because the bone growths do not injure 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, sensitivity along the nerve fibers is disturbed.

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, turn it to the side.
Pain in the interscapular region - in this case, the middle sections may be affected, from 3 to 6. Discomfort increases when both hands are moved to the side, inhaled deeply or turned.
Severe pain under the right and left shoulder blades - the articular discs from 6 to 12 are affected, the lower back may 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 does not go away for a long time at rest. This is due to constant compression of the nerve, which is aggravated by muscle spasm.

Radiculitis

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

As the disease progresses, additional symptoms may appear: >

There are backaches that radiate to the lower limb - a sharp stabbing pain is felt as an electric shock along the course of the nerve.
Burning pains in the back, in the lumbar region or below 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-shoulder periarthrosis

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

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-handed or left-handed). First, it appears after exercise, and then at rest. Along the way, additional symptoms appear:

headache;
hand numbness;
violation of the mobility of the spinal column.

With humeroscapular periarthrosis, the clinical manifestations increase when the arm is raised up - it hurts in the region of the right or left shoulder, shoulder blade. 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 supraspinous nerves - there is pain in the right or left shoulder blade from the back, concentrated mainly in the clavicle. Sometimes the discomfort spreads to the shoulder, which indicates the defeat of the skin branches of this area.
Subscapular and infraspinatus nerves - in this case, it hurts on the right or left under the scapula, depending on the side of the lesion. If the muscles of the same name are involved, the clinical manifestations are aggravated when the arms move down, abducted behind the back.
Intercostal nerves - usually 1-4 pairs. These branches go along the lower edge of the rib, pain occurs 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 for neuralgia - if the left half of the body was exposed to drafts, then pain is noted in the neck, chest and shoulder blade from this side.

Heart disease

Branches from the parasympathetic trunk, which is connected with the spinal cord and its roots, go to the heart. That is why cardiac diseases can provoke pain in the scapula and below. Usually a mild form of myocardial infarction is latent. It may be accompanied by the following symptoms:

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

Problems with the gastrointestinal tract

Similar to the previous mechanism, pain spreads along the nerve fibers. Clinical signs can be bilateral, but in most cases there is a certain pattern in which the symptoms appear according to 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, pallor of the skin, dark color of feces, decreased 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 below the shoulder blades can provoke:

Uncomfortable mattress - if it fails and you sleep on your 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 on a deep breath.
Poliomyelitis - pathology is accompanied by neurological symptoms, back pain often appears.
Intoxication - severe poisoning or a cold can be manifested by muscle 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 floor of the abdominal cavity, when inhaling, pain below the shoulder blades, fever and symptoms of intoxication will be felt.
Mental disorders - in some cases, pain in the shoulder blades and below may be the result of such disorders. The exact mechanism of occurrence has not been studied.

The nature of the pain

Soreness 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, lumbago is characteristic - a sharp stabbing pain that appears with a sharp turn of the body, raising the arm. This is the main difference from cholelithiasis, in which the symptom is not curled from movements.
Aching, throbbing or burning pain indicates a pathology of the internal organs. The latter option occurs when squeezing the roots of the spinal cord, but it increases with movement and can turn into stitching.
Severe constricting pain in the area of the shoulder blades and below is characteristic of a hernia. Sometimes it is preceded by lumbago, numbness of the limbs.
Cutting soreness of varying intensity is characteristic of neuralgia, drilling often accompanies inflammation of the joints.

Which doctor treats pain in the shoulder blades?

If you experience pain in the scapula and below, you need to make an appointment with a neurologist. If there is 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 area of the scapula and below, a laboratory and instrumental examination is performed:

X-ray or CT - using these methods, you can detect osteochondrosis, curvature of the spine and the consequences of injuries.
MRI >- the spinal column, shoulder joint or internal organs are examined, depending on the suspected pathology.
ECG - helps to identify cardiac diseases.
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 below 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 therapy program includes:

Medications – Analgesics are usually prescribed to relieve pain and inflammation. Then 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 - warm-up is carried out with damage to the spine. From such procedures, the muscles above and below the shoulder blades relax, posture improves. In this case, you need professional help from a chiropractor or osteopath.
Gymnastics - is carried out 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 will prevent recurrence of the pathology:

watch 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 prevention of somatic pathology (if it is 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, appear spontaneously.

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