Pain in the back between the shoulder bladesoccurs in spine pathologies (posture disorders, osteochondrosis, ankylosing spondylitis), esophageal diseases (gastroesophageal reflux disease, achalasia cardia, strictures), mediastinitis.Less often, the symptom develops against the background of aortitis, aortic dissection or malignant tumors of the mediastinum.The diagnostic complex includes radiography of the spine, OGK, CT and MRI, endoscopy.The state of blood vessels is assessed by ultrasound and aortography.Pain is relieved by prescribing NSAIDs or narcotic analgesics.Treatment of the underlying disease is represented by drugs, physiotherapeutic and surgical methods.
Causes of back pain between shoulder blades
Respiratory diseases
Pain between the shoulder blades occurs in acute tracheitis or bronchitis, when unpleasant sensations radiate from the chest to the back.At rest, the discomfort in the back is slight, but increases sharply when coughing, laughing or trying to talk loudly.The pain is dull in nature;burning and roughness in the interscapular area are less common.Symptoms last 3-7 days, disappear without a trace after the inflammatory process calms down.
Postural disorders
Often the causes of pain between the shoulder blades are scoliosis, kyphosis or lordosis.Symptoms develop when sitting for a long time in an uncomfortable position, after sleeping on a too soft or, conversely, very hard mattress.Dull or aching pain appears, which intensifies when bending or making sharp turns.Unpleasant sensations are observed already at a young age, which is related to the prevalence of postural disorders in children.
Similar signs are found in patients suffering from a specific juvenile pathology - Scheuermann-Mau's disease.In such cases, thoracic kyphosis increases, which is manifested by intense back pain and discomfort when staying in one position for a long time.As the disease progresses, adolescents feel a sharp pain between the shoulder blades, which occurs in the evening.
Thoracic osteochondrosis
Patients with degenerative spine disease suffer from dull pain in the back between the shoulder blades, which is caused by constant muscle tension and compression of nerve structures.The discomfort becomes stronger when turning and bending the body, standing or sitting for a long period of time.With severe pain, a person's daily physical activity is limited.
Severe interscapular pain is observed in herniated thoracic spine.If the upper thoracic segments are affected, the clinical picture is completed by numbness and tingling in the hands, and difficulty swallowing.The pathology of the middle thoracic part is characterized by intercostal neuralgia, and when the lower thoracic vertebrae are damaged, a sharp pain is felt in the epigastrium and under the ribs.
Ankylosing spondylitis
An early sign of the disease is discomfort primarily 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 in the morning, and decrease or disappear completely during the day.The pain goes away after a warm shower or bath or 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 region becomes constant and reduces the motor activity of the patient.Over time, a characteristic hump is formed on the back.A typical symptom of ankylosing spondylitis is sacroiliitis, inflammation of the sacroiliac joint.
Diseases of the esophagus
Most esophageal pathologies are characterized by pain radiating into the interscapular space.In this case, a clear connection is established between discomfort and food intake, physical activity with bending the body forward.Symptoms are supplemented by retrosternal burning sensation, heartburn and sour belching.Most often, back pain between the shoulder blades is caused by:
- COAT OF ARMS.Reflux esophagitis is characterized by a burning sensation behind the sternum and in the back 10-20 minutes after finishing a meal.Manifestations intensify if the patient assumes a lying position, bends a lot and performs physical work.Frequent heartburn and acid belching are observed.
- Achalasia cardia.If there is a violation of the opening of the lower esophageal sphincter, sharp retrosternal and interscapular pain occurs at the moment of swallowing.At first, symptoms appear sporadically - when you eat quickly, chew food poorly and swallow large pieces at the same time.Dysphagia then becomes permanent.
- Esophageal stenosis.The narrowing of the lumen of the organ is accompanied by difficulties in the passage of food bolus, which causes sharp pain 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 in the back.
Diaphragmatic hernia
It is characterized by severe pain that spreads throughout the upper part of the abdomen and passes into the interscapular area.Often, with a hiatal hernia, pain occurs in the precordial region, which is mistaken for an angina attack.Symptoms appear after eating, physical activity and exertion.To reduce discomfort, patients induce vomiting or belching and drink water.
Pathologies of the aorta
Back pain occurs with aortitis.Unpleasant sensations are localized between the shoulder blades, behind the sternum, sometimes moving to the neck or epigastric region.Painful burning in the chest and spreading to the back occurs less often.Pain is a constant concern and does not depend on the action of external factors.Tachycardia, shortness of breath on exertion, at rest and a dry cough are usually detected.
Excruciating retrosternal pain, radiating to the interscapular area and radiating from top to bottom, is seen in dissecting aortic aneurysms.Sometimes the feelings are so strong that the patient loses consciousness from the painful shock.The blood pressure drops, the pulse quickens, the brain is starved of oxygen.If a person is not given immediate medical attention, there is a high risk of death.
Mediastinitis
Intense pain that begins suddenly and is felt in the area between the shoulder blades is characteristic of acute posterior mediastinitis.The discomfort is increased by swallowing, throwing back the head and coughing.In order to reduce back pain and facilitate breathing, the patient sits with his head tilted forward, slightly hunched.Edema and cyanosis of the upper half of the body develop, and sometimes subcutaneous emphysema occurs.
Acute inflammation of the mediastinum is accompanied by massive intoxication, so the pain syndrome is accompanied by febrile temperature, weakness and cardiac dysfunction.With chronic mediastinitis, the symptoms are less pronounced: moderate dull pain in the back, behind the sternum, long-term low temperature and periodic swallowing disorders.
Mediastinal cancer
Pain in the retrosternal region, radiating to the area between the shoulder blades, is the main complaint of patients with malignant tumors of the mediastinum.The symptom appears in the late stage of the disease and is caused by the growth of the tumor into neighboring structures and nerve endings.Excruciating pain syndrome is combined with difficulty breathing and coughing when the bronchi are involved in the process, dysphagia when the esophagus is affected, swelling and cyanosis of the face when the superior vena cava is compressed.
Rare causes
- Injuries: fracture of the spine, spondylolisthesis, crack or fracture of the scapula.
- Muscle diseases: myalgia, myositis, muscle-tonic syndrome.
- Lung diseases: pneumonia, dry or exudative pleurisy.
Diagnostics
The initial examination is performed by an orthopedic traumatologist, who after a physical examination notices bad posture, curvature of the spine and other problems of the musculoskeletal system.If the pain between the shoulder blades is not related to bone pathology, the patient is advised by a cardiologist, neurologist or gastroenterologist.In order to reveal the etiological factors of back pain, instrumental studies are prescribed:
- X-ray of the spine.Based on 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 diagnosing thoracic osteochondrosis and helps in visualizing post-traumatic bone changes.In order to detect an intervertebral hernia, radiography is supplemented with CT or MRI of the spine.
- X-ray OGK.The standard research method allows us to exclude lung 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.In order to confirm the esophageal etiology of the pain, an endoscopic examination of the esophagus is performed.During the examination, the gastroenterologist pays attention to the patency of the organs, the coherence of the sphincter and studies the condition of the mucous membranes of the organs.Biopsies are taken from suspicious areas for histological analysis.
- Ultrasound angioscanning.Ultrasound scanning of the aorta is used as a screening method to detect inflammatory changes and aneurysms.To assess the state of the thoracic region, transesophageal echocardiography is performed.The diagnosis of dissecting aneurysm is confirmed by X-ray method - aortography.
- Laboratory methods.They play an auxiliary role in the diagnostic search.Patients undergo a standard complex: hemogram, biochemical blood test, test for hepatitis and HIV infection.According to the indications, a coagulogram is performed.In the case of a possible acute inflammatory process, the data on the indicators of the acute phase are informative.In patients with suspected ankylosing spondylitis, the HLA-B27 antigen is determined.
Because of the different causes of interscapular pain, additional testing may be necessary.If there are disorders of the upper respiratory tract, a consultation with an otolaryngologist and a complete ENT examination is necessary.If a malignant tumor of the mediastinum is suspected, oncologists are involved in the diagnosis.
Treatment
Help before diagnosis
Most non-drug measures are aimed at preventing pain between the shoulder blades: developing and maintaining proper posture, eating a balanced diet without harmful foods, leading an active lifestyle and playing sports.In case of severe pain during the diagnostic examination, 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 regimen is selected individually, taking into account the leading disease that caused the symptoms and accompanying pathologies.Orthopedic problems come to the fore by correcting posture with the help of corsets and other orthoses.The following groups of drugs are used to treat the cause of pain:
- Nonsteroidal anti-inflammatory drugs.It is prescribed to relieve pain in diseases of the osteoarticular system, as well as to eliminate inflammation and speed up recovery.NSAIDs are also effective in diseases of the respiratory organs and mediastinitis.
- Antisecretory drugs.Proton pump inhibitors and H2-histamine blockers are the basis for the treatment of GERD and achalasia cardia.Medicines reduce damage to the esophagus due to acidic stomach contents and relieve pain.To quickly relieve the burning sensation, non-absorbable antacids are taken.
- Antibiotics.Massive antimicrobial therapy is indicated for acute forms of mediastinitis to destroy pathogens and prevent bacterial complications.Medicines are chosen empirically.A combination of 2-3 agents is introduced to act on all possible types of microbes.
- Cytostatics.Polychemotherapy is chosen for some forms of mediastinal cancer as preparation for surgery or as palliative care.Immunosuppressants are sometimes recommended for patients with severe forms of ankylosing spondylitis.
Patients with acute conditions (aortic dissection, fulminant mediastinitis) are hospitalized in the intensive care unit.The goal of treatment is to eliminate the state of shock: cardiotropic drugs, infusion solutions and oxygen support are used for this purpose.Narcotic analgesics and sedatives are given for pain relief.
Non-medicinal methods play an important role in the treatment of musculoskeletal diseases.Special complexes of exercise therapy are prescribed to strengthen the muscular corset and form an even posture.Manual manipulation, kinesiotherapy, orthopedic massage of the chest, back and lower back show good results.Numerous physiotherapeutic methods are used: electrical stimulation of back muscles, peloid therapy, general ultraviolet radiation.
Surgical treatment
In case of persistent deformities of the spinal column, surgical correction of scoliosis is recommended.Surgical treatment of osteochondrosis is resorted to in case of compression of the spine: the intervertebral hernia is removed and the spinal canal is decompressed.As a rule, minimally invasive techniques are used: disc vaporization puncture, microdiscectomy.
Surgical interventions are indicated in complicated forms of diaphragmatic hernia and severe esophageal stenosis.The hernial opening is sutured by croraphy, gastropexy or fundoplication, resection and plastic surgery of the esophagus.Emergency surgery is the only treatment for dissecting aneurysms.Vascular surgeons perform resection of the damaged area with reconstruction of the aorta.