Back pain between shoulder bladesoccurs with pathologies of the spine (violations of posture, osteochondrosis, Bechterew's disease), diseases of the esophagus (gastroesophageal reflux disease, achalasia of the cardia, strictures), mediastinitis. Less often, the symptom develops against the background of aortitis, aortic dissection, malignant tumors of the mediastinum. The diagnostic complex includes radiography of the spinal column, OGK, CT and MRI, EFGDS. The condition of the vessels is assessed using ultrasound, aortography. Pain is relieved by the appointment of NSAIDs or narcotic analgesics. Treatment of the underlying disease is represented by medical, physiotherapeutic and surgical methods.
Causes of back pain between the shoulder blades
Pain between the shoulder blades occurs with acute tracheitis or bronchitis, when discomfort radiates from the chest to the back. At rest, discomfort in the back is insignificant, but it sharply increases during coughing, laughter, and when trying to talk loudly. The pains are dull in nature, burning and soreness in the interscapular zone are less likely to bother. Symptoms last 3-7 days, disappearing without a trace after the inflammatory process subsides.
Often the causes of pain between the shoulder blades are scoliosis, kyphosis or lordosis. Symptoms develop with prolonged sitting in an uncomfortable position, after sleeping on a too soft or, conversely, very hard mattress. Dull or aching pains appear, which are aggravated by bending, sharp turns. Unpleasant sensations are observed already at a young age, which is associated with the prevalence of posture disorders among children.
Similar signs are found in patients suffering from a specific juvenile pathology - Scheuermann's disease. In such cases, thoracic kyphosis increases, which is manifested by intense back pain, discomfort during prolonged stay in one position. With the progression of the disease, adolescents feel a sharp soreness between the shoulder blades that occurs in the evening.
Patients with degenerative lesions of the spine suffer from dull pain in the back between the shoulder blades, which is caused by constant muscle tension and compression of the nerve structures. Discomfort becomes stronger when turning and tilting the body, standing or sitting for a long time. With severe pain syndrome, daily physical activity of a person is limited.
Severe interscapular pain is noted with a hernia of the thoracic spine. If the upper thoracic segments are affected, the clinical picture is complemented by numbness and tingling in the hands, difficulty swallowing. The pathology of the midthoracic region is characterized by intercostal neuralgia, and if the lower thoracic vertebrae are damaged, sharp pains are felt in the epigastrium and under the ribs.
An early sign of the disease is discomfort predominantly 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 during the day they decrease or completely disappear. Soreness subsides after a hot shower or bath, 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, pain in the interscapular region becomes constant, reduces the patient's motor activity. Over time, a characteristic hump forms on the back. A typical sign of Bechterew's disease is sacroiliitis - inflammation of the sacroiliac joint.
Diseases of the esophagus
Most esophageal pathologies are characterized by pain radiating into the interscapular space. At the same time, a clear relationship is determined between discomfort and food intake, physical activity with forward bending of the torso. Symptoms are supplemented by retrosternal burning, heartburn, sour belching. Most often, back pain between the shoulder blades is caused by:
- GERD.For reflux esophagitis, a burning sensation behind the sternum and in the back area is typical 10-20 minutes after eating. Manifestations are aggravated if the patient takes a prone position, leans a lot and performs physical work. There are frequent heartburn, belching sour.
- Achalasia cardia.With violations of the opening of the lower esophageal sphincter, sharp retrosternal and interscapular pains occur at the time of swallowing. At first, symptoms appear sporadically - when eating in a hurry, chewing food poorly and swallowing large pieces at once. Then the dysphagia becomes permanent.
- Esophageal stenosis.The narrowing of the lumen of the organ is accompanied by difficulties in the passage of the food bolus, which causes severe 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 does not help to move it further and only increases the discomfort felt in the back.
It is characterized by severe pain that spreads over the upper abdomen and passes to the interscapular region. Often, with hiatal hernias, there is also pain in the precordial region, which is mistaken for an angina attack. Symptoms are noted after eating, exercise, straining. To reduce discomfort, patients cause vomiting or belching, drink water.
Pathologies of the aorta
Pain in the back occurs with aortitis. Discomfort sensations are localized between the shoulder blades, behind the sternum, sometimes they are shifted to the neck or epigastric region. Less often there is a painful burning sensation in the chest with irradiation to the back. Soreness worries constantly, does not depend on the action of external factors. Tachycardia, shortness of breath during physical exertion, at rest, dry hacking cough are usually detected.
Unbearable retrosternal pain, radiating to the interscapular zone and spreading from top to bottom, is observed with a dissecting aortic aneurysm. Sometimes the sensations are so strong that the patient loses consciousness from pain shock. Blood pressure drops, the pulse quickens, oxygen starvation of the brain occurs. If a person is not provided with emergency medical care, there is a high risk of death.
Intense pain that begins suddenly and is felt in the area between the shoulder blades is characteristic of acute posterior mediastinitis. Discomfort is aggravated by swallowing, tilting the head back, coughing. To relieve pain in the back and facilitate breathing, the patient sits with his head tilted forward, slightly hunched over. Edema and cyanosis of the upper half of the body develop, occasionally subcutaneous emphysema occurs.
Acute inflammation of the mediastinum is accompanied by massive intoxication, so the pain syndrome is accompanied by febrile fever, weakness, and cardiac disorders. In chronic mediastinitis, the symptoms are less pronounced: there are moderate dull pains in the back, behind the sternum, prolonged subfebrile condition, and periodic swallowing disorders.
Pain in the retrosternal region, which radiates to the area between the shoulder blades, is the main complaint of patients with malignant tumors of the mediastinum. The symptom occurs at a late stage of the disease, caused by the germination of the neoplasm in neighboring structures and nerve endings. Excruciating pain syndrome is combined with shortness of breath and cough when the bronchi are involved in the process, dysphagia - with damage to the esophagus, puffiness and cyanosis of the face - with compression of the superior vena cava.
- Injuries: fracture of the spine, spondylolisthesis, fissure or fracture of the scapula.
- Muscle diseases: myalgia, myositis, muscular-tonic syndrome.
- Pulmonary diseases: pneumonia, dry or exudative pleurisy.
The initial examination is carried out by an orthopedic traumatologist, who, after a physical examination, notices impaired posture, curvature of the spinal column and other problems of the musculoskeletal system. If the pain between the shoulder blades is not associated with bone pathology, the patient is consulted by a cardiologist, neurologist, gastroenterologist. To find out the etiological factors of pain in the back, instrumental studies are prescribed:
- Radiography of the spine.According to the results of the radiograph, the doctor determines the degree of scoliosis, the presence and severity of kyphosis or lordosis. The method is informative for the diagnosis of thoracic osteochondrosis, helps to visualize post-traumatic bone changes. To identify a herniated disc, radiography is supplemented by CT or MRI of the spine.
- X-ray of OGK.The standard research method makes it possible to exclude pulmonary diseases as one of the causes of pain between the shoulder blades. X-ray imaging also shows mediastinal shadow enlargement and signs of subcutaneous emphysema, which qualifies the clinician for a diagnosis of mediastinitis.
- EFGDS.To confirm the esophageal etiology of pain, an endoscopic examination of the esophagus is performed. In the study, the gastroenterologist pays attention to the patency of the organ, the coherence of the sphincters, studies the state of the mucous membrane of the organ. Biopsy specimens are taken from suspicious areas for histological analysis.
- Ultrasonic angioscanning.Ultrasound of the aorta is used as a screening method for detecting inflammatory changes, aneurysms. To assess the condition of the thoracic region, transesophageal echocardiography is performed. The diagnosis of exfoliating aneurysm is confirmed by X-ray method - aortography.
- Laboratory methods.They play a supporting role in the diagnostic search. Patients undergo a standard complex: a hemogram, a biochemical blood test, an analysis for hepatitis and HIV infection. According to the indications, a coagulogram is done. With a possible acute inflammatory process, data on acute phase indicators are informative. In patients with suspected ankylosing spondylitis, the HLA-B27 antigen is determined.
Given the variety of causes of interscapular pain, additional testing may be required. In the presence of violations of the upper respiratory tract, consultation with an otolaryngologist and a complete ENT examination are necessary. If a malignant tumor of the mediastinum is suspected, oncosurgeons are involved in the diagnosis.
Help before diagnosis
Most non-drug measures are aimed at preventing pain between the shoulder blades: the formation and maintenance of correct posture, rational nutrition without harmful products, maintaining an active lifestyle and playing sports. With a strong pain syndrome, the doctor prescribes non-narcotic analgesics for the duration of the diagnostic search, recommends limiting mobility, and, if necessary, prescribes strict bed rest.
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 comorbidities. With orthopedic problems, posture correction with the help of corsets and other orthoses comes to the fore. For the treatment of causes of pain, the following groups of medicines are used:
- Non-steroidal anti-inflammatory drugs. They are prescribed to relieve discomfort in diseases of the musculoskeletal system, as well as to eliminate inflammation and speed up recovery. NSAIDs are also effective in diseases of the respiratory organs, mediastinitis.
- Antisecretory drugs. Proton pump inhibitors and H2-histamine blockers are the basis of therapy for GERD and achalasia of the cardia. The drugs reduce damage to the esophagus by the acidic contents of the stomach, relieve pain. For quick relief of 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 selected empirically. A combination of 2-3 agents is introduced to act on all possible types of microbes.
- Cytostatics. Polychemotherapy is selected for some forms of mediastinal cancer as a 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 therapeutic measures is to get out of a state of shock: for this, cardiotropic drugs, infusion solutions are used, and oxygen support is provided. To stop the pain syndrome, narcotic analgesics, tranquilizers are administered.
In the treatment of musculoskeletal diseases, non-drug methods play an important role. Special complexes of exercise therapy are prescribed to strengthen the muscular corset, the formation of an even posture. A good effect is shown by manual effects, kinesiotherapy, orthopedic massage of the chest, back, lower back. A number of physiotherapeutic methods are used: electrical stimulation of the back muscles, pelotherapy, general UVI.
With persistent deformities of the spinal column, surgical correction of scoliosis is recommended. Operative treatment for osteochondrosis is resorted to in case of spinal compression: an intervertebral hernia is removed and the spinal canal is decompressed. As a rule, minimally invasive techniques are used: puncture vaporization of the disc, microdiscectomy.
Surgical interventions are indicated for complicated forms of diaphragmatic hernia, severe stenosis of the esophagus. The hernial orifice is sutured with crororaphy, gastropexy or fundoplication, resection and plastic surgery of the esophagus. Emergency surgery is the only treatment for a dissecting aneurysm. Vascular surgeons perform resection of the damaged area with reconstruction of the aorta.