Back pain between the shoulder bladesappears with spine pathologies (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 radiography of the spine, OGK, CT and MRI, endoscopy.The state of the vessels is assessed using ultrasound and aortography.Pain is relieved by prescribing NSAIDs or narcotic analgesics.Treatment of the underlying disease is represented by medication, 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, discomfort in the back is insignificant, but it increases significantly when you cough, laugh or when you try to speak loudly.The pain is dull in nature;burning and roughness in the interscapular area are less common.Symptoms last 3-7 days, disappearing without a trace after the inflammatory process subsides.
Postural disorders
Often the causes of pain between the shoulders are scoliosis, kyphosis or lordosis.Symptoms develop when you sit for a long time in an uncomfortable position, after sleeping on a mattress that is too soft or, conversely, too firm.A dull or aching pain appears, which intensifies when you bend or make sharp turns.Unpleasant sensations are already observed at a young age, which is associated with the spread of postural disorders in children.
Similar signs are found in patients suffering from a specific juvenile pathology - Scheuermann-Mau disease.In such cases, thoracic kyphosis intensifies, which is manifested by severe back pain and discomfort while staying in one position for a long time.As the disease progresses, teenagers feel a sharp pain between the shoulder blades, which appears in the evening.
Thoracic osteochondrosis
Patients with degenerative diseases of the spine 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 you twist and bend your body, stand or sit for long periods of time.With severe pain, a person's daily physical activity is limited.
Severe interscapular pain is observed with a hernia of the thoracic spine.If the upper chest segments are affected, the clinical picture is complemented by numbness and tingling in the hands and difficulty in 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 mainly in the lumbar spine, 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 disappear completely during the day.The pain is reduced after a hot shower or bath or physical activity.
The spread of the pathological process in 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 forms on the back.A typical symptom of ankylosing spondylitis is sacroiliitis, an inflammation of the sacroiliac joint.
Diseases of the esophagus
Most pathologies of the esophagus are characterized by pain radiating to the interscapular space.In this case, a clear connection is established between anxiety and food intake, physical activity with the body bending forward.Symptoms are complemented by a retrosternal burning sensation, heartburn and sour belching.Most often, back pain between the shoulders is caused by:
- GERD.For 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 a lot and performs physical work.Frequent heartburn and sour belching are noted.
- Achalasia cardia.If there is a violation of the opening of the lower esophageal sphincter, sharp retrosternal and interscapular pains appear at the moment of swallowing.At first, the symptoms appear sporadically - when you eat in a hurry, chew food poorly and swallow large pieces at once.Dysphagia then becomes permanent.
- Esophageal stenosis.The narrowing of the lumen of the organ is associated with difficulty in passing the bolus of food, which causes sharp pains 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 felt in the back.
Diaphragmatic hernia
It is characterized by severe pain that spreads throughout the upper abdomen and moves to the interscapular area.Often, with hiatal hernia, there is also pain in the precordial region, which is confused with an angina attack.Symptoms appear after eating, physical activity and strain.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 they move to the neck or epigastric region.Less often, a painful burning sensation appears 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 a dry cough are detected.
Excruciating retrosternal pain, radiating to the interscapular area and spreading from top to bottom, is observed with dissecting aneurysm of the aorta.Sometimes the sensations 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 emergency medical care, there is a high risk of death.
Mediastinitis
Intense pain that starts suddenly and is felt in the area between the shoulder blades is characteristic of acute posterior mediastinitis.Discomfort increases with swallowing, tilting the head back and coughing.To reduce back pain and facilitate breathing, the patient sits with the head tilted forward, slightly bent.Edema and cyanosis of the upper half of the body develop, and subcutaneous emphysema occasionally occurs.
Acute inflammation of the mediastinum is associated with massive intoxication, so the pain syndrome is accompanied by febrile 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, which radiates to the area between the shoulders, is the main complaint of patients with malignant tumors of the mediastinum.The symptom appears at a late stage of the disease and is caused by the growth of the tumor in neighboring structures and nerve endings.The syndrome of excruciating pain is combined with shortness of breath and cough 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
- INJURY: fracture of the spine, spondylolisthesis, tear or fracture of the scapula.
- Muscle diseases: myalgia, myositis, muscle-tonic syndrome.
- Pulmonary diseases: pneumonia, dry or exudative pleurisy.
Diagnosing
The initial examination is carried out 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 shoulders is not associated with bone pathology, the patient is consulted by a cardiologist, neurologist or gastroenterologist.To discover the etiological factors of back pain, instrumental studies are prescribed:
- X-ray of the spine.Based on the results of the radiography, 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, X-ray is supplemented with CT or MRI of the spine.
- X-ray of OGK.The standard research method allows us to exclude pulmonary diseases as one of the causes of pain between the shoulder blades.X-ray images also show the expansion 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 mucous membrane of the organ.Biopsies are taken from suspicious areas for histological analysis.
- Ultrasound angioscan.Ultrasound scanning of the aorta is used as a screening method for detecting inflammatory changes and aneurysms.To assess the condition of the chest region, transesophageal echocardiography is performed.The diagnosis of dissecting aneurysm is confirmed by the x-ray method - aortography.
- Laboratory methods.They play a supporting role in diagnostic research.Patients undergo a standard complex: hemogram, biochemical blood test, test for hepatitis and HIV infection.According to the indications, a coagulogram is performed.In 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.
Given the variety of causes of interscapular pain, additional testing may be required.If there are disorders of the upper respiratory tract, consultation with an otolaryngologist and a complete examination of the ENT 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 diagnostic research, the doctor prescribes non-narcotic analgesics, recommends restriction of 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 main disease that caused the symptoms and accompanying pathologies.In case of orthopedic problems, correcting the posture 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:
- Nonsteroidal anti-inflammatory drugs.It is prescribed to relieve discomfort in diseases of the osteoarticular system, as well as to eliminate inflammation and accelerate healing.NSAIDs are also effective for diseases of the respiratory organs and mediastinitis.
- Antisecretory drugs.Proton pump inhibitors and H2-histamine blockers are the mainstay of treatment for GERD and cardiac achalasia.Medicines reduce damage to the esophagus from acidic stomach contents and relieve pain.To quickly relieve the burning sensation, non-absorbable antacids are taken.
- Antibiotics.Mass 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.
- cytostatic.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 an acute condition (aortic dissection, fulminant mediastinitis) are admitted to the intensive care unit.The goal of treatment is to remove the state of shock: for this purpose, cardiotropic drugs, infusion solutions and oxygen support are provided.To relieve pain, narcotic analgesics and sedatives are administered.
Drug-free methods play an important role in the treatment of musculoskeletal diseases.Special exercise therapy complexes are prescribed to strengthen muscle corsets and form an even posture.Manual manipulation, kinesiotherapy, orthopedic massage of the chest, back and back show good results.A number of physiotherapeutic methods are used: electrical stimulation of the back muscles, peloidal therapy, general ultraviolet radiation.
Surgical treatment
For persistent spinal deformities, surgical correction of scoliosis is recommended.Surgical treatment for osteochondrosis is used in the case of spinal cord compression: the intervertebral hernia is removed and the spinal canal is decompressed.As a rule, minimally invasive techniques are used: vaporization with disc puncture, microdiscectomy.
Surgical interventions are indicated for complicated forms of diaphragmatic hernia and severe stenosis of the esophagus.The hernial orifice is sutured with cruroraph, 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.