Back pain between shoulder blades
Back pain between the shoulder blades occurs in spinal pathologies (posture disorders, osteochondrosis, ankylosing spondylitis), esophageal diseases (gastroesophageal reflux disease, achalasia of the cardia, strictures), mediastinitis. Less often, the symptom develops against the background of aortitis, aortic dissection, malignant tumors of the mediastinum. The diagnostic complex includes radiography of the spinal column, OGK, CT and MRI, EFGDS. The condition of the vessels is assessed using ultrasound, aortography. Pain is relieved by prescribing NSAIDs or narcotic analgesics. Treatment of the underlying disease is represented by medical, physiotherapeutic and surgical methods.
Causes of back pain between shoulder blades
Respiratory diseases
Posture disorders
Thoracic osteochondrosis
Bekhterev ‘s disease
Diseases of the esophagus
Diaphragmatic hernia
Pathology of the aorta
Mediastinit
Mediastinal cancer
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of back pain between shoulder blades
Respiratory diseases
Pain between the shoulder blades occurs with acute tracheitis or bronchitis, when unpleasant sensations radiate from the chest into the back. At rest, back discomfort is insignificant, but it increases dramatically during coughing, laughing, and when trying to talk loudly. The pains are dull in nature, burning and soreness in the interscapular zone are less likely to bother. Symptoms last 3-7 days, disappearing without a trace after the inflammatory process subsides.
Posture disorders
Often the causes of painful sensations between the shoulder blades are scoliosis, kyphosis or lordosis. Symptoms develop when sitting in an uncomfortable position for a long time, after sleeping on a mattress that is too soft or, conversely, very hard. There are dull or aching pains that increase with bends, sharp turns. Unpleasant sensations are observed at a young age, which is associated with the prevalence of posture disorders among children.
Similar signs are found in patients suffering from a specific juvenile pathology — Sheyerman-Mau disease. In such cases, thoracic kyphosis increases, which is manifested by intense back pain, discomfort with prolonged stay in one position. With the progression of the disease, adolescents feel a sharp soreness between the shoulder blades, which occurs in the evening.
Thoracic osteochondrosis
Patients with degenerative lesions of the spine suffer from dull back pain between the shoulder blades, which are caused by constant muscle tension and compression of nerve structures. Uncomfortable sensations become stronger when turning and bending the torso, standing or sitting for a long time. With severe pain syndrome, the daily physical activity of a person is limited.
Severe interscapular pain is noted with a hernia of the thoracic spine. If the upper thoracic segments are affected, the clinical picture is complemented by numbness and tingling in the hands, difficulty swallowing. The pathology of the middle thoracic region is characterized by intercostal neuralgia, and when the lower thoracic vertebrae are damaged, sharp pains are felt in the epigastrium and under the ribs.
Back pain between shoulder blades
Bekhterev ‘s disease
An early sign of the disease is discomfort mainly in the lumbar spine, but as ankylosing spondylitis progresses, symptoms spread to the back between the shoulder blades. Unpleasant sensations develop in the evening or at night, intensify by morning, and decrease or disappear completely during the day. Soreness subsides after a hot shower or bath, physical activity.
The spread of the pathological process to the thoracic spine is accompanied by increased kyphosis and tonic tension of the spinal muscles. Therefore, the pain in the interscapular area becomes permanent, reduces the patient’s motor activity. Over time, a characteristic hump on the back is formed. A typical sign of Bekhterev’s disease is sacroiliitis — inflammation of the sacroiliac joint.
Diseases of the esophagus
Most esophageal pathologies are characterized by the irradiation of pain into the interscapular space. At the same time, a clear connection is determined between discomfort and eating, physical exertion with the trunk tilted forward. Symptoms are complemented by chest burning, heartburn, acid belching. Most often , back pain between the shoulder blades causes:
GERD. For reflux esophagitis, a burning sensation behind the sternum and in the back area is typical 10-20 minutes after the end of the meal. Manifestations are intensified if the patient takes a lying position, bends down a lot and performs physical work. Frequent heartburn, acid belching are observed.
Achalasia of the cardia. With violations of the opening of the lower esophageal sphincter, sharp chest and interscapular pains occur at the time of swallowing. At first, symptoms appear episodically — when eating in a hurry, poor chewing of food and swallowing large chunks at once. Then dysphagia becomes permanent.
Esophageal stenosis. The narrowing of the lumen of the organ is accompanied by difficulties in passing the food lump, which causes sharp soreness in the chest, the space between the shoulder blades. The patient feels that the food is stuck in the middle of the esophagus, and swallowing movements do not help to move it further and only increase the discomfort felt in the back.
Diaphragmatic hernia
It is characterized by severe pain that spreads through the upper abdomen and passes to the interscapular area. Often, with hernias of the esophageal orifice of the diaphragm, there is also pain in the atrial region, mistaken for an attack of angina pectoris. Symptoms are noted after eating, physical exertion, straining. To reduce unpleasant sensations, patients cause vomiting or belching, drink water.
Pathology of the aorta
Pain syndrome in the back occurs with aortitis. Uncomfortable sensations are localized between the shoulder blades, behind the sternum, sometimes they shift to the neck or epigastric region. Less often there is a painful burning sensation in the chest with irradiation in the back. Soreness worries constantly, does not depend on the action of external factors. Tachycardia, shortness of breath during physical exertion, at rest, dry nasal cough are usually detected.
Unbearable chest pains, radiating into the interscapular zone and spreading from top to bottom, are observed with a delaminating aortic aneurysm. Sometimes the sensations are so strong that the patient loses consciousness from pain shock. Blood pressure drops, pulse quickens, oxygen starvation of the brain occurs. If a person is not provided with emergency medical care, there is a high risk of death.
Mediastinit
Intense pain, which begins suddenly and is felt in the area between the shoulder blades, is characteristic of acute posterior mediastinitis. Discomfort increases when swallowing, throwing back the head, coughing. To reduce back pain and ease breathing, the patient sits down with his head tilted forward, slightly hunched over. Edema and cyanosis of the upper half of the trunk develop, occasionally there is subcutaneous emphysema.
Acute inflammation of the mediastinum is accompanied by massive intoxication, so the pain syndrome is accompanied by febrile fever, weakness, cardiac disorders. With chronic mediastinitis, the symptoms are less pronounced: moderate dull pain in the back, behind the sternum, prolonged subfebrility, periodic swallowing disorders are observed.
Mediastinal cancer
Pain in the chest area, which radiate into the area between the shoulder blades, is the main complaint of patients with malignant tumors of the mediastinum. The symptom occurs at a late stage of the disease, caused by the germination of the neoplasm into neighboring structures and nerve endings. Excruciating pain syndrome is combined with shortness of breath and cough when the bronchi are involved in the process, dysphagia — when the esophagus is affected, puffiness and cyanosis of the face — with compression of the superior vena cava.
Rare reasons
Injuries: spinal fracture, spondylolisthesis, fracture or fracture of the scapula.
Muscle diseases: myalgia, myositis, musculotonic syndrome.
Pulmonological diseases: pneumonia, dry or exudative pleurisy.
Diagnostics
The initial examination is carried out by an orthopedic traumatologist, who, after a physical examination, notices a disturbed posture, curvature of the spinal column and other problems of the musculoskeletal system. If the pain between the shoulder blades is not associated with bone pathology, the patient is advised by a cardiologist, neurologist, gastroenterologist. To find out the etiological factors of back pain, instrumental studies are prescribed:
Radiography of the spine. According to the results of the X-ray, the doctor determines the degree of scoliosis, the presence and severity of kyphosis or lordosis. The method is informative for the diagnosis of thoracic osteochondrosis, helps to visualize post-traumatic bone changes. To detect an intervertebral hernia, radiography is supplemented by CT or MRI of the spine.
Radiography of OGK. The standard method of investigation makes it possible to exclude pulmonological diseases as one of the causes of pain between the shoulder blades. X-ray imaging also shows the expansion of the mediastinal shadow and signs of subcutaneous emphysema, which gives the doctor the right to diagnose mediastinitis.
EFGDS. To confirm the esophageal etiology of pain, an endoscopic examination of the esophagus is performed. During the study, the gastroenterologist pays attention to the patency of the organ, the coherence of the sphincters, studies the condition of the mucous membrane of the organ. Biopsies are taken from suspicious sites for histological analysis.
Ultrasound angioscanning. Aortic ultrasound is used as a screening method for detecting inflammatory changes, aneurysms. To assess the condition of the thoracic region, transesophageal echocardiography is performed. The diagnosis of a delaminating aneurysm is confirmed by X—ray method – aortography.
Laboratory methods. They play an auxiliary role in diagnostic search. Patients undergo a standard complex: a hemogram, a biochemical blood test, an analysis for hepatitis and HIV infection. According to the indications, a coagulogram is made. With a possible acute inflammatory process, data on acute phase indicators are informative. In patients with suspected Bekhterev’s disease, the HLA-B27 antigen is determined.
Given the variety of causes of interscapular pain, additional examination may be required. In the presence of disorders of the upper respiratory tract, an otolaryngologist’s consultation and a complete ENT examination are necessary. If a malignant tumor of the mediastinum is suspected, oncosurgeons are involved in the diagnosis.
Manual therapy for back pain
Manual therapy for back pain
Treatment
Help before diagnosis
Most non-drug measures are aimed at preventing pain between the shoulder blades: the formation and observance of correct posture, rational nutrition without harmful products, active lifestyle and sports. With severe pain syndrome, during the diagnostic search, the doctor prescribes non—narcotic analgesics, recommends limiting mobility, and, if necessary, prescribes strict bed rest.
Conservative therapy
In the treatment of back pain between the shoulder blades, a differentiated approach is used — the therapeutic scheme is selected individually, taking into account the leading disease that caused the symptoms and concomitant pathologies. With orthopedic problems, posture correction with corsets and other orthoses comes to the fore. The following groups of medications are used to treat the causes of pain:
Nonsteroidal anti-inflammatory drugs. They are prescribed to relieve discomfort in diseases of the bone and joint system, as well as to eliminate inflammation and accelerate recovery. NSAIDs are also effective in respiratory diseases, mediastinitis.
Antisecretory drugs. Proton pump inhibitors and H2-histamine blockers are the basis of therapy for GERD, cardia achalasia. The drugs reduce damage to the esophagus by the acidic contents of the stomach, relieve pain. For rapid relief of burning, non-absorbable antacids are taken.
Antibiotics. Massive antimicrobial therapy is indicated for acute forms of mediastinitis to destroy pathogens and prevent bacterial complications. Medications are selected empirically. A combination of 2-3 drugs is introduced to act on all possible types of microbes.
Cytostatics. Polychemotherapy is selected for some forms of mediastinal cancer as preparation for surgery or as palliative care. Immunosuppressants are sometimes recommended for patients with severe forms of Bekhterev’s disease.
Patients with acute conditions (aortic dissection, lightning mediastinitis) are hospitalized in the intensive care unit. The purpose of therapeutic measures is to get out of a state of shock: for this purpose, cardiotropic medications, infusion solutions are used, and oxygen support is provided. To stop the pain syndrome, narcotic analgesics and tranquilizers are administered.
Non-drug methods play an important role in the treatment of musculoskeletal diseases. Special exercise therapy complexes are prescribed to strengthen the muscular corset, form an even posture. Manual interventions, kinesiotherapy, orthopedic massage of the chest, back, and lower back show a good effect. A number of physiotherapeutic methods are used: electrical stimulation of the back muscles, peloid therapy, general UFO.
Surgical treatment
In case of persistent deformities of the spinal column, surgical correction of scoliosis is recommended. Surgical treatment for osteochondrosis is resorted to in the case of spinal compression: an intervertebral hernia is removed and decompression of the spinal canal is performed. As a rule, minimally invasive techniques are used: puncture vaporization of the disc, microdiscectomy.
Surgical interventions are indicated for complicated forms of diaphragmatic hernia, severe esophageal stenosis. Hernia gate suturing with cruroraphy, gastropexy or fundoplication, resection and plastic surgery of the esophagus are performed. Emergency surgery is the only method of treatment for a delaminating aneurysm. Vascular surgeons perform resection of the damaged area with aortic reconstruction.
