back pain between shoulder blades

back pain between shoulder bladesOccurs with spinal pathologies (postural disorders, osteochondrosis, ankylosing spondylitis), esophageal diseases (gastroesophageal reflux disease, achalasia, stenosis), mediastinitis.Less commonly, the symptoms occur in the context of aortitis, aortic dissection, or mediastinal malignancy.Diagnostic comprehensive includes spine X-ray, OGK, CT and MRI, endoscopy.Vascular status is assessed using ultrasound and aortography.Pain can be relieved by taking nonsteroidal anti-inflammatory drugs or narcotic analgesics.Treatment of underlying conditions includes medications, physical therapy, and surgery.

Causes of back pain between shoulder blades

respiratory diseases

Acute tracheitis or bronchitis can cause pain between the shoulder blades and discomfort radiating from the chest to the back.Discomfort in the back is not noticeable when resting, but increases dramatically when coughing, laughing, or trying to speak loudly.The pain is dull in nature; burning and tingling in the interscapular area are less common.Symptoms last for 3-7 days and disappear without a trace after the inflammation subsides.

postural disorder

Pain between the shoulder blades is usually caused by scoliosis, kyphosis, or lordosis.Symptoms can occur when you sit in an uncomfortable position for an extended period of time after sleeping on a mattress that is too soft or very hard.Dull pain or soreness occurs, and the pain worsens when bending or making sharp turns.Unpleasant sensations have been observed at an early age and are associated with the prevalence of postural disorders in children.

Similar symptoms have been found in patients with a specific juvenile pathology, Scheuermann's disease.In this condition, thoracic kyphosis increases, manifesting as severe back pain and discomfort when holding one position for extended periods of time.As the disease progresses, teens may experience severe pain between their shoulder blades at night.

Thoracic osteochondrosis

Patients with degenerative spinal disease experience dull pain in the back between the shoulder blades, which is caused by persistent muscle tension and compression of nerve structures.The discomfort is exacerbated when turning and bending the body, standing or sitting for long periods of time.Severe pain can limit a person's daily physical activities.

Severe interscapular pain occurs when the thoracic spine is herniated.If the upper thoracic region is affected, clinical manifestations may also include numbness and tingling in the hands and difficulty swallowing.The pathological feature of the mid-thoracic region is intercostal neuralgia, in which sharp pain is felt in the upper abdomen and under the ribs when the lower thoracic spine is damaged.

ankylosing spondylitis

Early symptoms of the disease are primarily discomfort in the lumbar spine, but as ankylosing spondylitis progresses, symptoms can spread to the back between the shoulder blades.The unpleasant sensation appears in the evening or night, intensifies in the morning, and decreases or disappears completely during the day.The pain may be relieved by taking a hot bath or bath or engaging in physical activity.

The spread of the pathological process to the thoracic spine is accompanied by an increase in kyphosis and tonic tension of the spinal muscles.As a result, pain in the interscapular region becomes persistent and reduces the patient's motor activity.Over time, a characteristic hump develops on the back.The classic symptom of ankylosing spondylitis is sacroiliitis, which is inflammation of the sacroiliac joints.

Esophageal diseases

Most esophageal lesions are characterized by pain radiating into the scapular space.In this case, there is a clear link between discomfort and food intake, physical activity of bending the body forward.Symptoms also include a burning sensation under the breastbone, heartburn, and sour belching.Most commonly, back pain between the shoulder blades is caused by:

• Gastroesophageal reflux disease.With reflux esophagitis, a burning sensation usually occurs 10-20 minutes after a meal in the area behind the breastbone and back.Symptoms may be exacerbated if the patient is recumbent, bends over a lot, and performs manual labor.Heartburn and acidic belching often occur.
• Achalasia.If the opening of the lower esophageal sphincter is violated, severe substernal and interscapular pain may occur during swallowing.At first, symptoms appear sporadically—when eating in a hurry, chewing food poorly, and when swallowing large chunks of food at once.The dysphagia then becomes permanent.
• Esophageal stricture.Narrowing of the lumen of the organ is accompanied by difficulty in passing food bolus, which can lead to severe 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 does not help move it further and will only increase the discomfort in the back.

Diaphragmatic hernia

It is characterized by severe pain that spreads throughout the upper abdomen and moves to the interscapular area.Often, hiatal hernia also presents with precordial pain, which is mistaken for an angina attack.Symptoms may appear after eating, physical activity, and exertion.To relieve discomfort, patients may induce vomiting or burping and drink water.

Aortic disease

Back pain occurs with aortitis.The discomfort is concentrated between the shoulder blades, behind the sternum, and sometimes moves to the neck or upper abdominal area.Less commonly, a painful burning sensation develops in the chest and radiates to the back.Soreness is an ongoing problem and is not dependent on the action of external factors.Tachycardia, shortness of breath on exertion, at rest, and a dry cough are usually detected.

Aortic dissecting aneurysms may be observed with excruciating retrosternal pain that radiates to the interscapular region and spreads from superior to inferior.Sometimes, the sensation is so intense that the patient loses consciousness in painful shock.Blood pressure drops, pulse speeds up, and the brain becomes deprived of oxygen.If a person does not receive emergency medical care, the risk of death is high.

Mediastinitis

Sudden, severe pain between the shoulder blades is characteristic of acute posterior mediastinitis.Swallowing, reclining, and coughing can increase discomfort.To reduce back pain and ease breathing, the patient tilts their head forward and bends slightly while sitting.Edema, cyanosis, and occasionally subcutaneous emphysema occur in the upper body.

Acute inflammation of the mediastinum is accompanied by massive poisoning, so the pain syndrome is accompanied by fever, weakness, cardiac insufficiency, etc.Symptoms of chronic mediastinitis are less obvious: moderate dull pain in the back and retrosternal region, prolonged low-grade fever, and periodic dysphagia.

mediastinal cancer

Pain in the retrosternal region radiating to the area between the shoulder blades is a major complaint in patients with mediastinal malignancies.The symptoms appear in the late stages of the disease and are caused by tumor growth into adjacent structures and nerve endings.When the bronchi are involved, a syndrome of extreme pain occurs with shortness of breath and coughing; when the esophagus is involved, dysphagia occurs; and when the superior vena cava is compressed, facial edema and cyanosis occur.

Rare causes

• Injuried: Spinal fracture, spondylolisthesis, cracked or fractured shoulder blade.
• muscle disease: Myalgia, myositis, muscle tension syndrome.
• lung disease: Pneumonia, dry or exudative pleurisy.

diagnosis

The initial examination was performed by an orthopedic traumatologist, who after a physical examination found poor posture, spinal curvature and other problems with the musculoskeletal system.If the pain between the shoulder blades is not related to bone pathology, the patient will consult a cardiologist, neurologist, or gastroenterologist.In order to find out the cause of back pain, instrumental studies are needed:

• Spine X-ray.Based on the X-ray results, doctors can determine the degree of scoliosis, whether kyphosis or lordosis is present, and how severe it is.This method provides information for the diagnosis of thoracic osteochondrosis and helps visualize post-traumatic bone changes.To detect intervertebral hernias, radiography is supplemented with CT or MRI of the spine.
• X-rays from OGK.Standard research methods allowed us to rule out lung disease as one of the causes of pain between the shoulder blades.X-ray imaging also shows signs of enlarged mediastinal shadows and subcutaneous emphysema, which precludes doctors from diagnosing mediastinitis.
• EFGDS.To confirm the cause of esophageal pain, an endoscopy of the esophagus is performed.During the examination, the gastroenterologist pays attention to the patency of the organ, the coherence of the sphincter muscles, and studies the condition of the organ's mucosa.Biopsies were taken from suspicious areas for histological analysis.
• Ultrasound vascular scan.Aortic ultrasound scanning is used as a screening method to detect inflammatory changes and aneurysms.To evaluate the condition of the chest area, a transesophageal echocardiogram is performed.The diagnosis of dissecting aneurysm is confirmed by X-ray method (aortography).
• Laboratory methods.They play a supporting role in diagnostic searches.Patients undergo a standard comprehensive examination: routine blood tests, biochemical blood tests, and tests for hepatitis and HIV infection.Perform a coagulogram as directed.If a possible acute inflammatory process occurs, data on acute phase indicators can be informative.HLA-B27 antigen assay in patients with suspected ankylosing spondylitis.

Given the variety of causes of interscapular pain, additional testing may be needed.If upper respiratory tract disease is present, an otolaryngologist needs to be consulted and a complete otolaryngology examination performed.If mediastinal malignancy is suspected, an oncologist is involved in the diagnosis.

treat

Pre-diagnosis help

Most non-pharmacological measures are aimed at preventing pain between the shoulder blades: developing and maintaining correct posture, eating a balanced diet free of harmful foods, leading an active lifestyle and participating in sports.If severe pain occurs during a diagnostic examination, the doctor will prescribe non-narcotic analgesics, recommend restriction of activity and, if necessary, prescribe strict bed rest.

Conservative treatment

In the treatment of back pain between the shoulder blades, a differentiated approach is adopted - treatment options are individually selected, taking into account the main disease causing the symptoms and accompanying pathologies.If orthopedic problems occur, posture correction may be necessary with the help of corsets and other orthotics.The following groups of medications are used to treat the cause of pain:

• NSAIDs.Used to relieve discomfort caused by diseases of the bone and joint system, as well as eliminate inflammation and accelerate recovery.NSAIDs are also effective in respiratory diseases and mediastinitis.
• antisecretory drugs.Proton pump inhibitors and H2-histamine blockers are the cornerstone of treatment for GERD and achalasia.These medications can reduce damage to the esophagus from acidic stomach contents and relieve pain.For quick relief from burning sensation, take a non-absorbable antacid.
• antibiotic.Massive antimicrobial therapy is indicated in acute mediastinitis to eliminate pathogens and prevent bacterial complications.Medications are chosen empirically.Introduce a combination of 2-3 agents to act on all possible types of microorganisms.
• cytostatic.For some forms of mediastinal cancer, combination chemotherapy is chosen as preparation for surgery or as palliative care.Immunosuppressants are sometimes recommended for patients with severe ankylosing spondylitis.

Patients with acute conditions (aortic dissection, fulminant mediastinitis) are hospitalized in the intensive care unit.The goal of treatment is to get out of the state of shock: for this, cardiotonic drugs are used, fluids are given and oxygen support is provided.To relieve pain, narcotic analgesics and sedatives are used.

Nonpharmacological approaches play an important role in the treatment of musculoskeletal disorders.Special exercise therapy strengthens muscle bundles and creates an even posture.Manual massage, sports therapy, and orthopedic massage of the chest, back, and waist have good effects.A variety of physical therapy methods are used: electrical stimulation of the back muscles, ball therapy, ordinary ultraviolet radiation.

surgical treatment

For persistent spinal deformity, surgical correction of scoliosis is recommended.In cases of spinal compression, osteochondrosis can be treated surgically: the intervertebral hernia is removed and the spinal canal is decompressed.Minimally invasive techniques are usually used: disc puncture vaporization, microdiscectomy.

Surgical intervention is indicated for complex forms of diaphragmatic hernia and severe esophageal strictures.The hernial opening is closed by cross suturing, gastropexy or fundoplication, esophagectomy and esophagoplasty.Emergency surgery is the only way to treat a dissecting aneurysm.Vascular surgeons remove the damaged area by reconstructing the aorta.