The scapula is a three-dimensional triangular bone that connects the humerus and the collarbone. It owes its name to its external resemblance to a well-known tool - a garden shovel. The socket of the scapula 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 strain and inflammation
A large number of muscles are attached to the scapula: subscapularis, coracohumeral, small and large rhomboid, deltoid. It most often hurts under the right shoulder blade because stretching or the development of an inflammatory process has occurred.
Stretching muscles can cause severe back stress, lifting and carrying weights, sudden movements, and prolonged uncomfortable body position. However, as practice shows, in more than half of the cases the cause is excessive physical effort of an unprepared person and improper exercise.
The symptoms of stretching are as follows:
- sharp pain of varying intensity;
- increased pain when turning and tilting the body;
- relief during rest;
- swelling and bruising (with severe damage).
The basic principle of treating sprains is complete rest and removal of stress. Immediately after the injury, you need to put ice or a cold compress on the sore spot, if necessary, take an anesthetic pill.
With muscle inflammation - myositis - we are in excruciating pain, which increases with pressure and movements. Sometimes there is mild swelling and redness. Often the general condition worsens: the body temperature rises, the head aches, and small painful seals are felt in the muscles.
The causes of myositis are different, but it usually develops against the background of acute respiratory viral infections, flu or tonsillitis. It should be noted that the muscles in the chest are relatively rarely inflamed, because 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 tissue. The process of ossification (ossification) can be localized almost anywhere - near the spine, on the limbs or in the pelvic region.
Reference:ossification of myositis is incurable and not even subject to surgical treatment. After the ossification is removed, they re-form.
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 (painful) points in the muscles. The diameter of each point varies from 1 to 3 mm, the accumulation of points can create a painful area of 1 cm2. These points occur under the influence of trauma and muscle strain.
Several factors can cause this process:
- skeletal anomalies - 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 addition to gallbladder pathologies, pain often radiates to the right shoulder blade. This is due to the contraction of smooth muscles when the walls of the bladder are irritated by the resulting 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 an acute, cutting character and in most cases occurs after consuming fatty, fried, spicy foods, alcoholic beverages. The cause of the attack may be heavy physical exertion, nervous exertion, or a prolonged tilt position.
If there is a blockage of the bile duct, the pain feels dull and recedes. The accompanying symptom is heaviness in the abdomen on the right side, as well as nausea, which turns into vomiting. It is possible to increase body temperature, sometimes to high values. Obstruction of the common bile duct and obstruction of the sphincter of Oddi develops jaundice, and the feces become discolored.
Treatment of gallstones can be conservative and surgical. In the absence of complications, specific therapy is not performed. Individual stones can be removed by shock wave lithotripsy.
Subphrenic abscess
Back pain in the shoulder blade area can be explained by the formation of a subphrenic abscess - an abscess localized below the diaphragm dome. It most often appears 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 can be inflammatory pathology of internal organs, open or closed abdominal trauma, as well as severe lung lesions, osteomyelitis of the spine and rib bones.
The general symptoms appear first - weakness, sweating and fever. Increased body temperature can be constantly maintained or occasionally rise. Then the upper third of the abdomen and the lower part of the chest on the affected side begin to ache. Pain syndrome of varying intensity often radiates below the shoulder blade, shoulder, or collarbone.
A characteristic sign of an abscess is difficulty breathing, 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 on time, the abscess penetrates the abdominal and pleural cavity, almost guaranteeing a fatal outcome.
Pleurisy
Pain near the shoulder blade can cause broncho-pulmonary disease - pneumonia or bronchitis, complicated by pleurisy. In this case, it can injure below and above the shoulder blade. However, the main sources of pain are the chest and upper abdomen.
Pleurisy is always a complication of some other 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 puncture it for evacuation or drainage. Depending on why pleurisy 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 develops in different ways: in some the symptoms are limited to one unpleasant episode, while others complain of regular exacerbations. In some cases, urolithiasis has a chronic, long-lasting course.
The main symptom is renal colic when the ureter is blocked. The localization of the pain syndrome depends on the location of the stone, and the intensity on its size. Pain in the right shoulder blade occurs when the right kidney is affected. If the stone is lower, then the lower back or lower abdomen hurts.
Typical symptoms of urolithiasis are frequent urge and burning when urinating, fever and nausea.
The method of treatment can be conservative and surgical. The operation is most often needed, 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 percentage of postoperative complications.
During the operation, the stones are crushed using a reflector that emits electrohydraulic waves. After crushing, stone particles and sand are excreted in the urine. Sometimes their movement along the urethra causes renal colic, which is easily stopped by medication.
Reference:any surgery does not guarantee the absence of recurrence. Therefore, complex therapy is necessarily carried out, which can last for several years.
Intercostal neuralgia
Intercostal neuralgia (thoracalgia) is characterized by severe symptoms and is most commonly manifested by acute, penetrating pain in the ribs, anterior and posterior. It can appear occasionally or constantly disturbing. The pain syndrome is painful, burning or dull, but always difficult to bear.
A characteristic sign of neuralgia is a sudden 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;
- gastric disorder (gastritis);
- age-related changes in blood vessels;
- metabolic disease;
- chest trauma;
- influenza, SARS;
- hypothermia and draft;
- prolonged or severe nervous stress;
- heavy physical activity;
- unsuccessful body rotation, prolonged stay in a static position.
Reference:intercostal neuralgia is characterized by pain lasting from a few seconds to three minutes. During this time, the patient tries to breathe or move so as not to increase the pain.
The mainstay of treatment is pain relief, for which nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed. For 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 aged 5 to 20 years.
Osteoma can grow asymptomatically and manifest only when the surrounding structures - nerve roots and blood vessels - constrict. Treatment is only surgical, virtually no recurrence.
Chondroma is a benign tumor that originates from the cartilaginous 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 radically removed.
Chondrosarcoma, like chondroma, forms cartilaginous tissue, but it is malignant and widespread. Its growth is accompanied by an increase in pain and swelling in the affected area.
Chondrosarcoma occurs in people of any age, even in children, but the highest percentage is in middle age - from 40 to 60 years. Mostly men suffer. The main method of treatment is tumor removal; if surgery is impossible, chemotherapy and radiotherapy are performed.
Ewing’s sarcoma is one of the most aggressive malignant tumors prone 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 surgery, chemotherapy and radiotherapy are given, using high doses and several medications. 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 a specialist consultation and examination. Based on his results, the doctor will prescribe treatment and give the necessary recommendations. Be healthy!