Back pain between the shoulder bladesit manifests itself with pathologies of the spine (postural disorders, osteochondrosis, ankylosing spondylitis), diseases of the esophagus (gastroesophageal reflux disease, cardiac achalasia, stenosis), mediastinitis.Less commonly, 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 by ultrasound and aortography.The 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 the shoulder blades
Respiratory diseases
Pain between the shoulder blades occurs with acute tracheitis or bronchitis, when unpleasant sensations radiate from the chest to the back.At rest, back discomfort is insignificant, but increases noticeably when coughing, laughing, or when trying to speak loudly.Pain is dull in nature;burning and rawness in the interscapular area are less common.Symptoms last 3-7 days and disappear without a trace after the disappearance of the inflammatory process.
Posture disorders
Often the causes of pain between the shoulder blades are scoliosis, kyphosis or lordosis.Symptoms appear when sitting for a long time in an uncomfortable position, after sleeping on a mattress that is too soft or, conversely, very hard.A dull or aching pain appears, which intensifies when bending or making sharp turns.Already at a young age, unpleasant sensations are observed, which are associated with the prevalence of postural disorders among children.
Similar signs are found in patients suffering from a specific juvenile pathology: Scheuermann-Mau disease.In these cases, thoracic kyphosis intensifies, which is manifested by intense back pain and discomfort when staying in the same position for a long time.As the disease progresses, adolescents experience severe pain between the shoulder blades, which occurs in the evening.
Thoracic osteochondrosis
Patients suffering from degenerative disease of the spine suffer from dull pain in the back between the shoulder blades, caused by constant muscle tension and compression of the nerve structures.The discomfort becomes stronger when turning and bending the body, standing or sitting for long periods of time.With severe pain, a person's daily physical activity is limited.
Severe interscapular pain is observed with a herniated thoracic spine.If the upper thoracic segments are affected, the clinical picture is complemented by numbness and tingling in the hands and difficulty swallowing.The pathology of the mid-thoracic region is characterized by intercostal neuralgia, and when the lower thoracic vertebrae are damaged, sharp pain is felt in the epigastrium and under the ribs.
Ankylosing spondylitis
An early sign of the disease is discomfort especially in the lumbar spine, but as ankylosing spondylitis progresses, symptoms spread to the back, between the shoulder blades.Unpleasant sensations appear in the evening or night, intensify in the morning and decrease or disappear completely during the day.The pain goes away after a hot 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, pain in the interscapular region becomes constant and reduces the patient's motor activity.Over time, a characteristic hump forms 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 irradiation of pain into the interscapular space.In this case, a clear connection is established between discomfort and food intake, physical activity with the body bent forward.The symptoms are complemented by a burning sensation in the sternum, heartburn and acid belching.Most often, back pain between the shoulder blades is caused by:
- GERD.In reflux esophagitis, a burning sensation behind the sternum and in the back area is typical 10-20 minutes after finishing a meal.Manifestations intensify if the patient takes a lying position, bends over a lot and performs physical work.Frequent heartburn and acid belching are observed.
- Cardiac achalasia.If there is a violation of the opening of the lower esophageal sphincter, severe retrosternal and interscapular pain occurs when swallowing.At first, symptoms appear sporadically: when you eat hastily, you chew food poorly and swallow large pieces at once.Dysphagia then becomes permanent.
- Esophageal stricture.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 has the sensation that the food is stuck in the center of the esophagus and the swallowing movements do not help to move it further and only increase the discomfort felt in the back.
Diaphragmatic hernia
It is characterized by severe pain that spreads to the entire upper abdomen and moves to the interscapular area.Often, with hiatal hernia, pain is also felt in the precordial region, which is mistaken for an angina attack.Symptoms occur after eating, exercising, and exerting yourself.To reduce discomfort, patients induce vomiting or belching and drink water.
Pathologies of the aorta
Back pain occurs with aortitis.Sensations of discomfort are localized between the shoulder blades, behind the sternum, sometimes moving to the neck or epigastric region.Less commonly, a painful burning sensation occurs in the chest and radiates to the back.Pain is a constant concern and does not depend on the action of external factors.Typically, tachycardia, shortness of breath during exertion, at rest and dry cough are detected.
In dissecting aortic aneurysm, unbearable retrosternal pain is observed, which radiates to the interscapular area and spreads from top to bottom.Sometimes the sensations are so strong that the patient loses consciousness due to painful shock.Blood pressure decreases, pulse accelerates, oxygen starvation occurs in the brain.If a person does not receive emergency medical care, the risk of death is high.
Mediastinitis
Severe pain that begins suddenly and is felt in the area between the shoulder blades is characteristic of acute posterior mediastinitis.Discomfort increases with swallowing, throwing the head back and coughing.To reduce back pain and facilitate breathing, the patient sits with his head tilted forward, slightly curved.Edema and cyanosis of the upper half of the body develop, and subcutaneous emphysema occasionally occurs.
Acute inflammation of the mediastinum is accompanied by massive intoxication, so the pain syndrome is accompanied by feverish fever, weakness and cardiac dysfunction.In chronic mediastinitis, the symptoms are less pronounced: moderate, dull pain in the back, behind the sternum, prolonged low-grade fever and periodic swallowing disorders are observed.
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 occurs in an advanced stage of the disease and is caused by tumor growth in nearby structures and nerve endings.Excruciating pain syndrome is combined with shortness of breath and cough when the bronchi are involved, dysphagia when the esophagus is affected, swelling and cyanosis of the face when the superior vena cava is compressed.
Rare causes
- Injuries: spine fracture, spondylolisthesis, crack or fracture of the scapula.
- Muscle diseases: myalgia, myositis, tonic muscle 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 associated with bone pathology, the patient is consulted by a cardiologist, neurologist or gastroenterologist.To find out 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 the diagnosis of thoracic osteochondrosis and helps to visualize post-traumatic bone changes.To detect intervertebral hernia, radiography is supplemented with CT or MRI of the spine.
- X-ray of the OGK.The standard research method allows you to exclude lung diseases as one of the causes of pain between the shoulder blades.X-ray imaging also shows an enlargement of the mediastinal shadow and signs of subcutaneous emphysema, which gives the doctor the right to diagnose mediastinitis.
- EFGDS.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 organ, the coherence of the sphincters and studies the condition of the mucosa of the organ.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 evaluate the condition of the thoracic region, transesophageal echocardiography is performed.The diagnosis of dissecting aneurysm is confirmed by an X-ray method - aortography.
- Laboratory methods.They play a supporting role in diagnostic research.Patients undergo a standard complex: complete blood count, biochemical blood test, tests for hepatitis and HIV infection.According to indications, a coagulogram is performed.In case of a possible acute inflammatory process, data on indicators of the acute phase are informative.In patients with suspected ankylosing spondylitis, the HLA-B27 antigen is determined.
Given the variety of causes of interscapular pain, further testing may be necessary.If upper respiratory tract disorders are present, 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-pharmacological measures are aimed at preventing pain between the shoulder blades: developing and maintaining correct posture, following a balanced diet without harmful foods, leading an active lifestyle and playing sports.In case of severe pain during diagnostic research, 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 treatment regimen is selected individually, taking into account the main disease that caused the symptoms and concomitant pathologies.In case of orthopedic problems, posture correction with the help of corsets and other orthoses comes to the fore.The following groups of drugs are used to treat the causes of pain:
- Non-steroidal anti-inflammatory drugs.Prescribed to relieve discomfort in diseases of the osteoarticular system, as well as to eliminate inflammation and speed up recovery.NSAIDs are also effective in respiratory diseases and mediastinitis.
- Antisecretory drugs.Proton pump inhibitors and histamine H2 antagonists are the basis for the treatment of GERD and cardiac achalasia.The drugs reduce damage to the esophagus caused by acidic stomach contents and relieve pain.To quickly relieve the burning sensation, non-absorbable antacids are taken.
- Antibiotics.Massive antimicrobial therapy is indicated in acute forms of mediastinitis to destroy pathogens and prevent bacterial complications.Drugs 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 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: for this purpose, cardiotropic drugs, infusion solutions are used, and oxygen support is provided.Narcotic analgesics and tranquilizers are administered to relieve pain.
Non-pharmacological methods play an important role in the treatment of musculoskeletal diseases.Special physical therapy complexes are prescribed to strengthen the muscle corset and form an even posture.Manual manipulation, kinesitherapy, orthopedic massage of the chest, back and lower back show good results.A number of physiotherapeutic methods are used: electrical stimulation of the back muscles, peloid therapy, general ultraviolet radiation.
Surgical treatment
For persistent spinal deformities, surgical correction of scoliosis is recommended.In case of spinal compression, surgical treatment of osteochondrosis is used: the intervertebral hernia is removed and the spinal canal is decompressed.Minimally invasive techniques are usually used: vaporization with disc puncture, microdiscectomy.
Surgical interventions are indicated for complicated forms of diaphragmatic hernia and severe stricture of the esophagus.The hernial orifice is sutured with crurorrhaphy, 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.