Pain under the left shoulder blade

Pain under the left shoulder blade is observed in musculoskeletal pathology (osteochondrosis, myofascial syndrome, injuries), heart diseases (myocardial infarction, angina pectoris, rheumatic and non-rheumatic carditis), gastrointestinal diseases (pancreatitis, stomach ulcer). Rare causes of the symptom include spleen damage, ulcers and skin neoplasms. 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 medication or surgical treatment of the underlying disease is carried out.

Causes of pain under the left shoulder blade
Radicular syndrome
Myofascial pain syndrome
Injuries
Boils and carbuncles
Cardiac diseases
Pancreatitis
Stomach ulcer
Diseases of the spleen
Bronchopulmonary pathologies
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of pain under the left shoulder blade
Radicular syndrome
The pathological condition develops with thoracic osteochondrosis or intervertebral hernia. Less often, root pains occur with spondylolisthesis, ankylosing spondylitis. Acute soreness in the projection of the left scapula is noted when the 3-6 thoracic roots are involved in the process, discomfort directly under the scapula indicates the localization of damage in the 7-8 vertebrae. Usually there is a spread of pain from the shoulder blade to the lateral surface of the chest and intercostals.

Myofascial pain syndrome
Violations of posture and prolonged stay in an uncomfortable position lead to constant muscle tension. The syndrome is manifested by pain in the area of the scapula on the left, when the load is mainly on this side. The discomfort is felt by the patient as deep and moderately intense. At first, soreness is experienced only with movement, loads, but over time it becomes constant. Sometimes there are giving pains in the forearm or left hand.

Injuries
Intense pain develops after a crack or fracture of the scapula, bruising of soft tissues over this area. If the integrity of the bone is preserved, the soreness is expressed moderately, a person can take deep breaths and move freely. With traumatic damage to bone structures, sharp pains occur, the mobility of the arm and shoulder girdle is often limited. When changing the position or pressing on the injured area, sharp soreness is felt.

Pain under the left shoulder blade
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. During the maturation of the boil, “twitching” sensations arise, which increase when the inflammation zone is palpated or rubbed with clothes. After the rupture of the tire and the exit of the necrotic rod, the soreness decreases. With carbuncle, the pain is more intense, and the general condition of the patient often worsens.

Cardiac diseases
Heart damage is a typical cause of pain under the left shoulder blade, which is associated with the proximity of the anatomical location and features of innervation. In this case, the symptoms are accompanied by pain behind the sternum of various kinds, a feeling of fading or interruptions in the work of the heart. Tachycardia and other rhythm disturbances are usually detected. Pains under the shoulder blade are manifested:

Myocardial infarction. Patients experience unbearable burning sensations that spread from the atrial region to the left arm and shoulder blade, less often to the clavicle and neck area. The condition occurs suddenly, accompanied by a strong fear of death, a pre-fainting state.
Stable angina pectoris. Episodes of compressive or pressing pains radiating into the scapular zone are specific for CHD attacks. Unpleasant symptoms are provoked by physical exertion or emotional overstrain, last on average up to 10-15 minutes. After resting or taking nitrates, the soreness disappears.
Inflammatory heart diseases. Dull or stabbing pains in the chest, which are given to the left shoulder blade and bother the patient for several days, are typical for acute carditis (myocarditis, pericarditis). A person also complains of shortness of breath, fever, 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 arthralgias, ring-shaped erythema on the skin, rheumatic nodules. Symptoms are more often detected in children and adolescents.
Pancreatitis
Shingles, which pass from the left hypochondrium to the scapular region, are observed in acute pancreatic inflammation. In addition to the pain syndrome, patients are concerned about debilitating vomiting with admixtures of bile and mucus, tension of the abdominal muscles. Movements increase the painful sensations, so a person tries to lie on his side motionless.

In chronic pancreatitis, the irradiation of soreness under the shoulder blade indicates an exacerbation of the process. Violations are often provoked by errors in the diet — an abundant feast, alcohol intake. The pains are paroxysmal in nature, sometimes spread not only to the scapular, but also to the precardial region. Symptoms are combined with nausea, flatulence, 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 for 20-50 minutes after the end of the meal. The earlier the symptoms occur, the higher the ulcer is located. Discomfort becomes more severe when eating sour, spicy or fried food. To reduce the intensity of pain, patients cause vomiting.

Diseases of the spleen
Soreness and a feeling of bursting in the left scapular zone occurs with splenomegaly caused by infectious, autoimmune or myeloproliferative processes. With a gradual increase in the organ, periodic discomfort develops with heaviness in the affected area, and a rapid change in the size of the spleen is accompanied by acute cutting pains that give under the left shoulder blade.

Somewhat less often, surgical pathologies of the spleen become the cause of pain: rupture, heart attack, inversion. At the same time, there are cutting or pulsating pains with irradiation under the shoulder blade, which worsen with the slightest movement. Therefore, the patient takes a forced position: lying on his left side or on his back with his knees tucked up to his stomach. The clinical picture is complemented by a sharp drop in blood pressure, tachycardia. In the absence of adequate anesthesia, 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, laughter and conversation, a coughing attack. The pains have a diverse 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 moderate dull pain, which has a clear localization with focal inflammation of the lungs or spreads throughout the scapular area with croup pneumonia. There is a deep cough with the release of mucopurulent sputum. Symptoms last up to 2-4 weeks.
Pleurisy. With exudative pleurisy, a person experiences pressure and swelling under the shoulder blade and along the side wall of the chest. When feeling this area, uncomfortable sensations increase. Dry pleurisy is characterized by acute pain in the chest and in the scapular area, aggravated during movements.
Tuberculosis. Tuberculosis infection lasts for a long time, so low-intensity pain persists for several months. If the painful sensations are localized in the scapula area, it is more likely that the pathological focus is located in the posterior segments of the lung.
Lung infarction. The death of a section of the pulmonary parenchyma is manifested by a severe pain syndrome, which radiates under the left shoulder blade, clinically resembling an attack of angina pectoris. The condition of patients is complicated by hemoptysis or pulmonary bleeding, impaired respiratory function, arrhythmias.
Rare reasons
Neoplasms: osteoma and osteosarcoma, bone cyst, malignant tumors of the skin above the shoulder blade (basal cell carcinoma, melanoma).
Rare cardiovascular pathologies: cardiac syndrome X, descending aortic aneurysm.
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 is no violation of the musculoskeletal system, other specialists are involved in the diagnostic search: neurologist, cardiologist, surgeon, etc. To determine the causes of painful sensations, a full range of instrumental studies is assigned, which includes:

Radiography. A radiograph of the scapula in a straight and lateral projection allows you to exclude or confirm traumatic damage. Radiation imaging of the spine is indicated for suspected osteochondrosis, scoliosis, spondylolisthesis. Overview radiography of the OGC allows you to suspect lung or heart damage.
Electrocardiogram. A standard ECG in 12 leads is a screening method, according to the results of which the doctor makes a preliminary diagnosis, identifies dangerous processes (myocardial infarction, life—threatening arrhythmias). The diagnostic complex is complemented by classical or transesophageal echocardiography, cardiac EFI.
Ultrasound of the abdominal cavity. A fast and non-invasive method is used to detect typical conditions that cause pain in the left shoulder blade. Ultrasound examination shows signs of stomach ulcers, inflammatory infiltration of the pancreas, enlargement of the spleen. To clarify the diagnosis of peptic ulcer disease, EFGDS is used.
Additional methods. To clarify the nature and severity of bone changes, CT or MRI of the spine is performed. In case of probable bronchopulmonary diseases, bronchoscopy with biopsy, pleural puncture is performed. In case of difficulties in the diagnosis of abdominal pathology, diagnostic laparoscopy is recommended.
Laboratory methods of examination play an important role in the diagnosis. A clinical blood test shows signs of inflammation or impaired hematopoiesis. Indicators of acute-phase proteins and proteinograms are informative in case of possible damage to the heart or an autoimmune process. Specific myocardial markers are evaluated 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 inflammatory processes of the lungs and pleura, bacteriological sowing of biomaterial is necessary, followed by a test for the sensitivity of isolated microorganisms to antibiotics.

Massage of the back and the scapular area
Treatment
Help before diagnosis
Given the variety of causes manifested by pain under the left shoulder blade, it is extremely difficult for a doctor to make recommendations before identifying the underlying pathology. At the time of the examination, it is desirable to reduce the load on the back muscles in order to exclude banal fatigue and overstrain, which can cause a persistent pain symptom complex. With unbearable sensations, 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. With severe pain, therapeutic blockades, the introduction of narcotic analgesics are effective. Taking into account the disease, the mode of motor activity is selected.

Drug therapy is prescribed by a specialist of the appropriate profile. In case of pain against the background of heart damage, the cardiologist prescribes antianginal and antiarrhythmic drugs, antiplatelet agents and anticoagulants, antihypertensive drugs. Diseases of the bronchopulmonary system require the participation of a pulmonologist and the use of antibiotics, expectorants, specific anti-tuberculosis drugs.

In case of gastrointestinal pathologies, a suitable diet is selected, therapy is supplemented with enzyme preparations, prokinetics, antacids and antisecretory medications. In neurology, neurometabolic agents, B vitamins, drugs that improve microcirculation and rheological properties of blood are shown to eliminate the radicular syndrome.

In case of posture disorders, other problems with the spine, non-drug methods are actively used: traction therapy, therapeutic massage, physical therapy. Among the physiotherapeutic methods, balneotherapy (sulfide and radon baths), mud therapy, reflexotherapy are popular. It is possible to increase the effectiveness of drug treatment with the help of electrophoresis of drugs directly to the affected area.

Surgical treatment
Operative methods are indicated when conservative treatment is ineffective or in acute life-threatening pathologies, when procrastination is dangerous for the life and health of the patient. The second group of operations includes methods of stenting, angioplasty and bypass surgery for myocardial infarction, the help of abdominal or thoracic surgeons for injuries, purulent processes, internal bleeding.

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