Shoulder and subcutaneous pain may occur in nerve damage, spinal cord, shoulder girdle disease, or somatic pathologies. The cause can be determined based on clinical symptoms, conditions for syndrome manifestation, and medical history.
Pain can be felt in the shoulder area when inhaled, in half of the body and or all over the arm. In some cases, these symptoms are the "first bell" of the exacerbation period that can be prevented after the provocative factor is determined.
Causes and localization
Under-shoulder pain usually occurs during movement - preceded by an awkward turn with a long stand with a bent back. Indicates local damage that occurs for a variety of reasons.
Pathologies with unilateral lesions in which only the right or left side hurts under the shoulder blade are few - usually the severity of the symptom is individual. This is due to the symmetrical arrangement of the nerve roots protruding from the spinal cord.
If it hurts under the right and left shoulder blades, it may be due to damage to the bones and musculoskeletal system. The symptoms do not have a strict localization, their severity depends on the traumatic factor. The clinic usually starts acute, suddenly, and becomes chronic.
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 and under the shoulder blades hurt, swelling and local inflammation develop. After 2-3 weeks, the symptoms go away.
- Cracks and fractures are more severe injuries, with the pain concentrated in the shoulder blade itself. It intensifies even with the slightest movement, the patient cannot move his arm, he cannot bend.
- Sublux and displacement of the vertebrae - this causes joint pain at and below the shoulder blades, sometimes the bone structures compress the nerve roots.
Injuries are characterized by severe pain below the right or left shoulder that appears spontaneously. Cracking may occur during exercise, often with swelling.
If the disease affects the thoracic spine, the patient has back pain near and below the shoulder blades. This is due to pinching of the nerves or spinal cord due to deformity of the articular disc. The pathology develops gradually, and as the distance between the vertebrae decreases, the pathology clinic worsens.
The location of the pain depends on the affected area:
- If osteochondrosis destroys the joint plates of the chest region from 2 to 6, there may be pain in the shoulder area. It usually radiates to the neck and arms. When the vessels are compressed, dizziness appears and the intracranial pressure may increase.
- If the joints of segments 6-12 are affected, the pain radiates below the left or right scapula, spreading lower, to the corresponding half of the body and the lower back.
The spinal roots of the thoracic region form plexuses that innervate the arms and trunk. Therefore, when they are squeezed, the pain spreads along their trajectory.
In osteochondrosis, the discomfort is one-sided - depending on the obliqueness of the spine, the scapula hurts to the right or left and bottom.
This is the transverse curvature of the spine due to the tension in the muscles that support posture. This leads to pinching of the roots and spinal cord, the appearance of pain under the right or left shoulder blade. The pathology is usually accompanied by:
- Respiratory insufficiency - the unilateral obliqueness of the spine deforms the chest, affecting the functioning of the lungs, one of which is compressed and the other takes over the lost function.
- Violation of the work of the heart - the frequency of contractions and changes in heart rate, shortness of breath and pallor of the skin appear.
- The appearance of visible chest deformity is the main cause of pain under the right or left shoulder blade. The vertebrae move laterally with the ribs, causing the bone structures to shift downward on the side of the curvature and damage the spinal cord with its branches.
If the spinal cord is compressed during scoliosis, the back usually hurts between and below the shoulder blades, the focus is severely limited. When muscle cramps join, the symptom spreads to adjacent structures.
It is characterized by a backward bending of the spine, a protrusion of the shoulder girdle, and a gradual appearance of the bending. There is pain above the shoulder blade - it usually affects both sides of the arm and neck. The following mechanisms are involved in its development:
- Neurogenic - due to the curvature, the distances between the vertebral bodies decrease in the anterior sections, causing the branches of the spinal cord to become pinched. Aching pain occurs in the right and left shoulder blades, which can radiate to the collarbone, neck, and shoulders.
- Muscular - Deflection of the spine leads to overstretching of the muscles in the collar zone, which can cause painful spasms in and under the shoulder blades.
As a result of kyphosis, the vertebral artery is compressed and the cerebral circulation is disrupted. The work of the internal organs is gradually deteriorating.
If the right or left scapula hurts, one of the causes may be spondylarthrosis - damage to the faceted joints and intervertebral discs. It results in loss of mobility, stiffness appears, most pronounced in the morning.
The clinical picture changes as the pathology progresses: >
- Destruction of cartilage - in the absence of blood circulation, the integrity of the connective tissue is damaged, the articular disc becomes fragile, damaged and recovers more slowly. At this stage, strenuous physical exertion leads to microtrauma, pain that radiates to and under the shoulder blades.
- Deformity of the articular disc - seals appear that impede mobility. This causes 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 an advanced stage of the disease. Tumors damage the joints, muscles, blood vessels and nerves.
In spondylarthrosis, the back can hurt between or below the shoulder blades - the attack is usually preceded by physical activity. At rest, the symptoms are relieved because the bone outgrowth does not damage the surrounding tissues.
Protrusion and hernia
In such cases, there is concern about acute pain under the left and right scapula due to compression of the spinal cord or its roots. As a result of entrapment, sensitivity is disturbed along the nerve fibers.
The localization of the symptoms is as follows:
- Pain in and over the shoulder blades - protrusion or hernia in the cervical region of the neck, or if 1-3 chest segments are affected. The symptom intensifies as you try to tilt your head, turn it to the side.
- Pain in the interscapular region - in which case the middle sections may be affected, 3 to 6. The discomfort is increased when you move both hands to the side, take a deep breath, or turn them.
- Severe pain under the right and left shoulder blades - 6-12 joint plates are involved, the lower back may be involved in the pathology. In this case, there is a risk of developing a hernia because this spinal section is more stressed than the previous ones.
Unlike spondylarthrosis, the pain of a hernia and protrusions does not go away at rest. This is due to the constant compression of the nerve, which is exacerbated by muscle cramps.
It is a pinch of the lumbar roots that gather in a strong sciatic nerve. If the upper sections are affected, the patient feels pain under and below the shoulder blade, aggravated by bending and sudden movements.
As the disease progresses, additional symptoms may appear: >
- There are back pains that radiate to the lower limb - sharp stabbing pain can be felt as an electric shock along the nerve.
- Burning pain in the back, lumbar region, or under the shoulder blades indicates prolonged pinching of the spinal roots in the lumbar region.
- Cramps and loss of sensation usually occur in the lumbar region, buttocks, and sometimes numbness along the nerve fibers in the thighs, legs and feet.
By this condition we mean inflammation of the shoulder joint and surrounding tissues, stiffness that only disappears after warming up.
Pain is concentrated in and below the right or left scapular region, depending on the development of hemispheric motor skills (right or left-handed). Appears first after training and then at rest. Additional symptoms occur along the way:
- numbness of the hands;
- violation of spinal mobility.
In humeroscapular periarthrosis, clinical manifestations are exacerbated when the arm is raised — pain in the right or left shoulder, shoulder area. The range of motion gradually decreases, the stiffness progresses.
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 commonly affected:
- Suprascapular and supraspinal nerves - the right or left scapula hurts from behind, mainly in the clavicle. Sometimes the discomfort spreads to the shoulder, indicating the defeat of the skin branches in this area.
- Nervous and infraspinatus nerves - in which case it hurts under the scapula on the right or left side, depending on the side of the lesion. If the muscles of the same name are affected, the clinical manifestations worsen as the arms move down, abducted behind the back.
- Intervertebral nerves - usually 1 to 4 pairs. These branches run along the lower edge of the rib, the pain occurring not only in the area and below the shoulder blades but also on the sides of the chest, sometimes on the front.
Symmetry is not typical of neuralgia - if the left half of the body has been exposed to a draft, pain is felt in the neck, chest and shoulder blades from this side.
The branches of the parasympathetic trunk associated with the spinal cord and its roots go toward the heart. Therefore, heart disease can cause pain in the shoulder blade and below. Usually, a mild form of myocardial infarction is latent. This may be accompanied by the following symptoms:
- Dull pressing or burning pain behind the sternum or under the left scapula may last for hours, may increase while walking, but will pass slightly at rest.
- Shortness of breath - accompanied by pain, may occur within a few days.
- Tachycardia - increased heartbeat, sometimes with arrhythmias.
- Other symptoms include increased pressure, dizziness, nausea and vomiting.
Problems in the gastrointestinal tract
As with the previous mechanism, pain spreads along nerve fibers. Clinical symptoms may be bilateral, but in most cases there is a certain pattern in which symptoms appear according to the location of the internal organs.
Pain in the back of the left shoulder occurs with the following diseases:
- peptic ulcer.
Usually, patients with these conditions complain of dyspeptic disorders, nausea, and vomiting. In case of internal bleeding, pale skin, dark stool color, decreased pressure and weakness are observed.
Pain under the right shoulder is accompanied by:
- ulcerative lesions of the duodenum.
In addition to these factors, pain under the shoulder blades can provoke:
- Uncomfortable mattress - if it breaks down and you sleep on your right side, you may feel pain from behind under your left shoulder in the morning as the curved spine pinches the roots of the spine.
- Pleurisy - pain in the shoulder blade occurs when the sheets are rubbed against each other and reaches its peak when you take a deep breath.
- Poliomyelitis - the pathology is accompanied by neurological symptoms, often accompanied by back pain.
- Poisoning - Severe poisoning or colds may include muscle aches, chills and fever.
- VVD - vegetovascular dystonia is associated with pressure changes, cardiac arrest and shortness of breath, and sometimes discomfort in the back.
- Kidney disease - such pathologies are characterized by aching or stinging pain under the right shoulder blade, diuresis and discolouration of the urine, as well as general symptoms.
- Subdiaphragmatic abscess - if suppuration is observed at the upper level of the abdominal cavity, pain under the shoulder blades, fever and symptoms of intoxication may occur.
- Mental Disorders - In some cases, the shoulder blades and pain underneath may be the result of such disorders. The exact mechanism of occurrence has not been studied.
The nature of pain
The pain in and under the shoulder blades may be different, a specific group of pathologies may be presumed by nature, and sometimes a provocative factor can be identified:
- The pinched nerves are characterized by lumbago - a sharp stinging pain that occurs when the body is turned sharply and the arm is raised. This is the main difference from gallbladder inflammation in which the symptom does not warp from movement.
- Aching, throbbing, or burning pain indicates pathology of the internal organs. The latter possibility occurs when the roots of the spinal cord are compressed, but increases with movement and can become sutures.
- Severe astringent pain in the area below and below the shoulder blades is characteristic of the hernia. Sometimes lumbago, preceded by numbness of the limbs.
- Cutting pain of varying intensity is characteristic of neuralgia, drilling is often accompanied by arthritis.
Which doctor treats shoulder pain?
If you feel pain under and under your shoulder, you should make an appointment with a neurologist. If there is no pinched nerve, the specialist will refer you to an orthopedic, cardiologist, gastroenterologist or urologist, depending on the suspected disease.
In order to identify the cause of the discomfort in and below the scapula, a laboratory and instrumental examination shall be carried out:
- X-ray or CT - these methods can show osteochondrosis, curvature of the spine and the consequences of injuries.
- MRI >- examination of the spine, shoulder joint or internal organs as a function of suspected pathology.
- ECG - helps identify heart disease.
- Blood and urine tests are for information only for certain somatic pathologies, myositis and arthritis.
- Ultrasound - prescribed for somatic diseases when it is impossible to undergo an MRI.
Usually, pain under the shoulder blades occurs due to neurology. Therefore, CT and MRI are considered the "gold standard" of the diagnostic protocol.
General principles of treatment
The main task is to eliminate the symptoms and the provocative factor. The patient's well-being is first stabilized and then the underlying pathology is treated.
The therapeutic program includes:
- Medications - Painkillers are usually prescribed to relieve pain and inflammation. Then, depending on the underlying disease, funds are prescribed - antibiotics, stomach protectors, diuretics.
- Physiotherapy - strengthens the spine, treats somatic diseases. Medical electrophoresis is used in the field of shoulder blades, heating procedures, SWT.
- Massage - warming up is done by injuring the spine. From such procedures, the muscles above and below the shoulder blades relax and the posture improves. In this case, you need the professional help of a chiropractor or chiropractor.
- Gymnastics - takes place after the pain has been eliminated, the program is compiled by a physiotherapist and a rehabilitation specialist, depending on the illness suffered.
After successful treatment, patients should follow a prevention program that prevents recurrence of the pathology:
- pay attention to your posture;
- choose a medium-hard mattress and an orthopedic pillow;
- twice a week massage in and under the shoulder blades;
- follow a low calorie diet for obesity;
- get rid of bad habits;
- prevention of somatic pathology (if present in the history);
- see your doctor every six months.
Pain in and below the shoulder blades may be neurological or somatic in nature. If the nerves are damaged, the symptoms are acute and appear suddenly, spontaneously.
The pathologies of the internal organs and joints are characterized by gradual and prolonged pain, and the clinic is always accompanied by additional symptoms. In the initial phase, painkillers are prescribed, and after diagnosis, the program is supplemented with etiological therapy and strengthening procedures.