The scapula is a three-dimensional triangular bone that connects the humerus and the clavicle. Its name is due to the external resemblance to a well-known tool - a garden shovel. The socket of the shoulder blade and the head of the humerus form the shoulder joint, which is the most flexible joint in the human skeleton.
Pain under the right shoulder blade from the back in most cases indicates pathology of the articular elements of the shoulder, spine or paravertebral (paravertebral) structures. Other possible causes are damage to internal organs - bronchi, lungs, kidneys and gallbladder. Persistent shoulder pain syndrome almost always indicates a serious problem that requires medical and sometimes surgical treatment.
Muscle tension and inflammation
A large number of muscles are attached to the scapula: subscapularis, cruciate ligament, small and large rhomboid, deltoid. Most often it hurts under the right shoulder blade because there is stretching or an inflammatory process.
Muscle stretching can cause severe back stress, lifting and carrying weights, sudden movements and prolonged body discomfort. However, as practice shows, in more than half of the cases the cause is excessive physical exertion by an unprepared person and improper exercise.
The symptoms of sprains are as follows:
- acute pain of varying intensity;
- increased pain when turning and tilting the body;
- relief during rest;
- swelling and bruising (with severe damage).
The main principle of treatment of sprains is complete rest and elimination of stress. Immediately after the injury you should apply ice or a cold compress to the affected area, if necessary, take an anesthetic pill.
In inflammation of the muscles - myositis - the painful pain is anxious, which increases with pressure and movement. Sometimes there is a slight swelling and redness. Often the general condition worsens: the body temperature rises, the head hurts, and small painful seals are felt in the muscles.
The causes of myositis are varied, but most often develop against the background of acute respiratory viral infections, influenza or tonsillitis. It should be noted that the muscles in the chest area are relatively rarely inflamed, as myositis is localized mainly in the upper back or lower back.
One of the varieties 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 tissues. The process of ossification (ossification) can be localized almost anywhere - near the spine, limbs or pelvic area.
Reference:ossifying myositis is incurable and not even amenable to surgical treatment. After removing the ossicles, they form 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 whom are women.
Myofascial syndrome is a progressive condition characterized by the formation of trigger (pain) points in the muscles. The diameter of each point varies from 1 to 3 mm, the accumulation of dots can create a painful area of 1 cm2. These points are formed under the influence of trauma and muscle tension.
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;
- diseases of the spine - osteochondrosis, spondyloarthritis, as well as hernias and bulges;
- long-term use of drugs-β-blockers, cardiac glycosides, calcium antagonists, antiarrhythmic drugs, anesthetics;
- connective tissue damage in autoimmune diseases - rheumatism, lupus erythematosus.
Cholelithiasis
In pathologies of the gallbladder, the pain is often transmitted to the right shoulder blade. This is due to smooth muscle spasm, when the walls of the bladder are irritated by the formed stones (stones). An attack of biliary colic occurs, as a rule, suddenly and is concentrated on the right side below the ribs.
The pain syndrome has a sharp, cutting character and in most cases occurs after consuming fatty, fried, spicy foods, alcoholic beverages. The cause of an attack can be heavy physical exertion, nervous tension or a prolonged inclined position.
If there is a blockage of the bile duct, the pain feels dull and pulling. An accompanying symptom is heaviness in the abdomen on the right, as well as nausea that turns into vomiting. It is possible to raise the body temperature, sometimes to high values. When the common bile duct is blocked and the sphincter of Oddi is blocked, jaundice develops and the stools become discolored.
Treatment of gallstone disease can be conservative and surgical. In the absence of complications, no specific therapy is performed. Single stones can be removed using shock wave lithotripsy.
Subphrenic abscess
Pain in the back of the shoulder blades can be explained by the formation of a subphrenic abscess - an abscess located below the dome of the diaphragm. It most often occurs after abdominal surgery, when peritonitis develops. The causative agent may be staphylococcus, streptococcus or E. coli.
The 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 may be inflammatory pathology of the internal organs, open or closed abdominal trauma, as well as severe lung lesions, osteomyelitis of the spine and ribs.
First, general symptoms appear - weakness, sweating and fever. Elevated body temperature can be maintained constantly or raised periodically. It then begins to ache in the upper third of the abdomen and lower chest on the affected side. Pain syndrome of varying intensity often radiates under the shoulder blade, shoulder or clavicle.
Typical signs of an abscess are shortness of breath, dry cough, hiccups and increased pain when moving, deep breathing, coughing and sneezing. The patient breathes often and shallowly, trying to take a semi-sitting position.
Treatment of subphrenic abscess consists of surgical opening and drainage of the abscess, followed by antibacterial, anti-intoxication, anti-inflammatory and restorative therapy.
Reference:if the operation is not performed in time, the abscess penetrates the abdominal and pleural cavities, which almost guarantees a lethal outcome.
Pleurisy
Pain near the shoulder blade can cause bronchopulmonary diseases - 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 chest 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.
In 25% of patients with pleurisy, a malignant tumor is diagnosed - mesothelioma or metastases from other organs (mammary gland, ovaries). Metastatic pleurisy usually has mild symptoms and is often manifested only by pain behind the sternum.
When a large amount of exudate accumulates, it is necessary to break through for its evacuation or drainage. Depending on why pleurisy has developed, specific treatment is prescribed. It may include antibiotics, steroids, anti-inflammatory drugs. The tuberculous form is treated with special drugs.
Urolithiasis disease
The formation of stones in the urinary system most often occurs in middle-aged people - from 25 to 50 years. The disease progresses in different ways: in some the symptoms are limited to a single unpleasant episode, while others complain of regular exacerbations. In some cases, urolithiasis has a chronic, prolonged course.
The main symptom is renal colic when the ureter is blocked. The location of the pain syndrome depends on the location of the stone, and the intensity depends on its size. Pain in the right shoulder blade occurs when the right kidney is affected. If the stone is lower, then it hurts the lower back or lower abdomen.
Typical symptoms of urolithiasis are frequent urges and a burning sensation when urinating, fever and nausea.
The method of treatment can be conservative and surgical. Most often an operation is required, the indications for its implementation are:
- large stones;
- development of renal failure;
- localization of stones in the kidneys, renal pelvis or ureter;
- purulent pyelonephritis.
Surgery can be open or endoscopic. Shock wave lithotripsy is the most gentle method to reduce the rate of postoperative complications.
During the operation, the stones are crushed with the help of a reflector that emits electrohydraulic waves. After crushing, stone particles and sand are excreted in the urine. Sometimes their movement through the ureter causes renal colic, which is easily stopped with medication.
Reference:each operation is not a guarantee of no recurrence. Therefore, it is mandatory to conduct complex therapy, which can last several years.
Intercostal neuralgia
Intercostal neuralgia (thoracalgia) is characterized by severe symptoms and most often presents with sharp, piercing pain in the ribs, both anteriorly and posteriorly. It may appear intermittently or constantly disturbing. The pain syndrome is painful, burning or dull, but always difficult to tolerate.
A characteristic sign of neuralgia is a sharp increase in pain when inhaling, changing body position or sneezing. Often during a painful attack the muscles twitch, sweating increases, the skin becomes red or, conversely, pale. Numbness occurs at the site of damage to nerve endings.
The immediate cause of the pathology is pinching of the nerve roots, which is facilitated by various factors and diseases:
- osteochondrosis;
- spondylitis;
- ankylosing spondylitis;
- primary and metastatic tumors;
- stomach upset (gastritis);
- age-related changes in blood vessels;
- metabolic diseases;
- chest trauma;
- flu, SARS;
- hypothermia and currents;
- prolonged or severe nervous stress;
- high physical activity;
- unsuccessful rotation of the body, 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 increase the pain.
The main treatment is to relieve the pain syndrome, for which non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed. In case of severe pain, therapeutic blockades with anesthetics and steroids are performed. Sedatives are used to increase the CNS excitability threshold.
Specific therapy depends on the origin of the neuralgia and may include antivirals, antihistamines and muscle relaxants.
Neoplasms
Bone tumors in the scapula are very rare and can be both benign and malignant. The former include osteoma and chondroma, the latter chondrosarcoma and Ewing's sarcoma. Osteoma is characterized by slow growth and favorable course. It mainly affects children and young people from 5 to 20 years.
Osteoma can grow asymptomatically and appear only when the surrounding structures - nerve roots and blood vessels - are compressed. The treatment is only surgical, there are practically no recurrences.
Chondroma is a benign tumor originating from cartilage tissue. It should be noted that when chondroma is localized in the scapula, the tumor often degenerates into malignant. Due to the high risk of malignancy, such formations are removed radically.
Chondrosarcoma, like chondroma, is formed from cartilage tissue, but is malignant and widespread. Its growth is accompanied by increasing pain and swelling in the affected area.
Chondrosarcoma occurs in people of all ages, even children, but the highest percentage is in the middle age - from 40 to 60. Suffer mainly men. The main method of treatment is removal of the tumor; if it is impossible to perform the operation, chemotherapy and radiation therapy are performed.
Ewing's sarcoma is one of the most aggressive malignancies predisposed to early metastases. It affects children and young people, manifests itself in severe symptoms - pain, swelling and redness.
Because the tumor is highly aggressive, both surgical and therapeutic treatments are performed. Both before and after the operation, chemotherapy and radiation therapy are performed, as well as with the use of high doses and several drugs. The prognosis of the disease is conditionally unfavorable.
Pain under the right shoulder blade can be a completely harmless symptom or indicate a serious illness. To get rid of the pain and prevent possible complications, you need specialized consultation and examination. Based on the results, the doctor will prescribe treatment and give the necessary recommendations. Be healthy!