Back pain between the shoulder bladesIt occurs with pathologies of the spine (postural disorders, osteochondrosis, ankylosing spondylitis), diseases of the esophagus (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 X-ray of the spine, OGK, CT and MRI, endoscopy.The condition of the vessels is assessed using ultrasound and aortography.Pain is relieved by prescribing NSAIDs or narcotic analgesics.Treatment of the main disease is represented by drugs, physiotherapeutic and surgical methods.
Causes of back pain between the shoulder blades
Respiratory diseases
Pain between the shoulder blades occurs with acute tracheitis or bronchitis, unpleasant sensations spread from the chest to the back.At rest, the discomfort in the back is insignificant, but increases sharply when coughing, laughing or trying to speak loudly.The pain is dull;Burning and rawness in the interscapular area is less common.Symptoms last 3-7 days, disappear without a trace after the inflammatory process subsides.
Postural disorders
Often the causes of pain between the shoulder blades are scoliosis, kyphosis or lordosis.Symptoms develop after sitting in an uncomfortable position for a long time, after sleeping on a very soft or, conversely, very hard mattress.Dull or aching pain appears, intensifies when bending or making sharp turns.Unpleasant sensations are already observed at a young age, which is associated with the prevalence of postural disorders among children.
Similar symptoms are found in patients suffering from a certain juvenile pathology - Scheuermann-Mau disease.In such cases, thoracic kyphosis increases, which manifests itself in severe back pain and discomfort when staying in one position for a long time.As the disease progresses, teenagers feel a sharp pain between the shoulder blades that occurs in the evening.
Thoracic osteochondrosis
Patients with degenerative spinal disease suffer from dull pain in the back between the shoulder blades, which is caused by constant muscle tension and compression of nerve structures.Discomfort increases when turning and bending the body, standing or sitting for a long time.With severe pain, a person's daily physical activity is limited.
Severe interscapular pain is observed with a torn thoracic spine.If the upper chest segments are affected, the clinical picture is completed by numbness and tingling in the hands, difficulty in swallowing.The pathology of the middle chest is characterized by intercostal neuralgia, and when the lower thoracic vertebrae are damaged, sharp pains are felt in the epigastrium and under the ribs.
Ankylosing spondylitis
The initial symptom of the disease is primarily discomfort in the lumbar region, but as ankylosing spondylitis progresses, the 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 completely disappear during the day.The pain subsides 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 stable and reduces the motor activity of the patient.Over time, a characteristic hump appears on the back.A typical symptom of ankylosing spondylitis is sacroiliitis, an inflammation of the sacroiliac joint.
Diseases of the esophagus
Most esophageal pathologies are characterized by pain radiating to the interscapular space.In this case, a clear connection is established between anxiety and food intake, forward bending of the body and physical activity.Symptoms are complemented by retrosternal burning sensation, heartburn and sour belching.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 10-20 minutes after eating is characteristic.Manifestations intensify if the patient takes a lying position, bends too much and does physical work.Heartburn and sour belching are often observed.
- Achalasia cardia.If there is a violation of the opening of the lower esophageal sphincter, acute retrosternal and scapular pain occurs at the moment of swallowing.At first, symptoms appear sporadically - eating in a hurry, chewing food poorly and swallowing large pieces at once.Then the dysphagia becomes permanent.
- Esophageal stenosis.The narrowing of the organ lumen is accompanied by difficulties in the passage of a food bolus, which causes sharp pain in the chest, 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 it move further and only increase the discomfort felt in the back.
Diaphragmatic hernia
It is characterized by severe pain that spreads along the upper abdomen and passes to the interscapular region.Often, with a hiatal hernia, there is also pain in the precordial region, which is mistaken for an angina attack.Symptoms occur after eating, physical activity, and exertion.To reduce discomfort, patients induce vomiting or belching and drink water.
Aortic pathologies
Back pain occurs with aortitis.Discomfort is localized between the shoulder blades, behind the sternum, and sometimes passes to the neck or epigastric region.Less often, a painful burning sensation occurs in the chest and spreads to the back.Pain is a constant concern and does not depend on the influence of external factors.Tachycardia, shortness of breath on exertion and rest and dry cough are typically detected.
A dissecting aortic aneurysm presents with excruciating retrosternal pain radiating to the interscapular region and radiating from top to bottom.Sometimes the sensations are so strong that the patient faints from the painful shock.Blood pressure drops, the pulse quickens, the brain is starved of oxygen.If a person is not given emergency medical care, the risk of death is high.
Mediastinitis
Acute posterior mediastinitis is characterized by sudden onset of severe pain in the area between the shoulder blades.Discomfort increases with swallowing, throwing back the head and coughing.To reduce back pain and facilitate breathing, the patient sits in a slightly bent position with his head bent forward.Edema and cyanosis of the upper half of the body develop, sometimes subcutaneous emphysema occurs.
Acute inflammation of the mediastinum is accompanied by mass intoxication, so the pain syndrome is accompanied by fever, weakness, heart failure.In chronic mediastinitis, the symptoms are less pronounced: moderately dull pain in the back, behind the sternum, long-lasting low-grade fever, periodic swallowing disorders are observed.
Mediastinal cancer
Pain in the retrosternal area, radiating 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 and is caused by the growth of the tumor to neighboring structures and nerve endings.The unbearable pain syndrome is combined with shortness of breath and cough when the bronchi are involved in the process, dysphagia when the esophagus is affected, facial swelling and cyanosis 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 carried out by an orthopedic traumatologist who, after a physical examination, notes poor 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 consulted by a cardiologist, neurologist or gastroenterologist.Instrumental studies are prescribed to study the etiological factors of back pain:
- X-ray of the spine.Based on the X-ray results, 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 and helps to visualize bone changes after trauma.X-rays are supplemented with CT or MRI of the spine to detect an intervertebral hernia.
- X-ray of OGK.The standard research method allows to exclude lung diseases as one of the causes of pain between the shoulder blades.X-ray examination also shows the expansion of the mediastinal shadow and signs of subcutaneous emphysema, which gives the doctor the right to diagnose mediastinitis.
- EFGDS.An endoscopic examination of the esophagus is performed to confirm the esophageal etiology of the pain.During the examination, the gastroenterologist pays attention to the openness of the organ, the compatibility of the sphincters, and studies the condition of the mucous membrane of the organ.Biopsies are taken from suspicious areas for histological analysis.
- Ultrasound angioscanning.Ultrasound examination of the aorta is used as a screening method to detect inflammatory changes and aneurysms.Transesophageal echocardiography is performed to assess the condition of the thoracic region.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, information on acute phase indicators is informative.HLA-B27 antigen is determined in patients suspected of ankylosing spondylitis.
Considering the different causes of interscapular pain, further examination may be required.If there are disorders of the upper respiratory tract, an otorhinolaryngologist's consultation and a complete ENT examination are necessary.If you suspect a malignant tumor of the mediastinum, oncologists are involved in the diagnosis.
Treatment
Help before diagnosis
Most non-medical 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 search, the doctor prescribes non-narcotic analgesics, recommends limiting mobility and, if necessary, prescribes strict bed rest.
Conservative therapy
A different approach is used in the treatment of back pain among shoulder blades - the therapeutic regimen is selected individually, taking into account the leading disease that causes the symptoms and accompanying pathologies.Posture correction with the help of corsets and other orthoses comes to the fore in case of orthopedic problems.The following drug groups are used to treat the causes of pain:
- Nonsteroidal anti-inflammatory drugs.In diseases of the osteoarticular system, it is prescribed to relieve discomfort, as well as to eliminate inflammation and accelerate healing.NSAIDs are also effective for respiratory diseases and mediastinitis.
- Antisecretory drugs.Proton pump inhibitors and H2-histamine blockers are the mainstay of treatment for GERD and achalasia cardia.Medicines reduce damage to the esophagus from stomach acidity and relieve pain.Non-absorbable antacids are taken to quickly relieve the burning sensation.
- Antibiotics.Mass 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 used to affect all possible types of microbes.
- Cytostatics.Polychemotherapy is chosen as preparation for surgery or palliative care for some forms of mediastinal cancer.Immunosuppressants are sometimes recommended for patients with severe forms of ankylosing spondylitis.
Patients with an acute condition (aortic dissection, fulminant mediastinitis) are placed in the intensive care unit.The goal of treatment is to get rid of the shock state: for this purpose, cardiotropic drugs, infusion solutions, and oxygen support are used.Narcotic analgesics and tranquilizers are prescribed to relieve pain.
Non-drug methods play an important role in the treatment of diseases of the musculoskeletal system.Special exercise therapy complexes are prescribed to strengthen the muscle corset and create an even posture.Manual manipulation, kinesiotherapy, orthopedic massage of the chest, back, and back give good results.A number of physiotherapeutic methods are used: electrical stimulation of back muscles, peloid therapy, general ultraviolet radiation.
Surgical treatment
For persistent deformities of the spine, surgical correction of scoliosis is recommended.Surgical treatment of osteochondrosis is applied in case of compression of the spine: the intervertebral hernia is removed and the spinal canal is decompressed.As a rule, minimally invasive methods are used: puncture vaporization of the disc, microdiscectomy.
Surgical interventions are indicated for complicated forms of diaphragmatic hernia and severe stenosis of the esophagus.The hernial opening is repaired by cryorrhaphy, gastropexy or fundoplication, resection and plasty of the esophagus.Emergency surgery is the only treatment for a dissecting aneurysm.Vascular surgeons perform resection of the damaged area by reconstructing the aorta.