Back pain between the shoulder blades

Back pain between the shoulder bladesoccurs with pathologies of the spine (postural disorders, osteochondrosis, ankylosing spondylitis), diseases of the esophagus (gastroesophageal reflux disease, achalasia cardia, strictures), mediastinitis.Less commonly, the symptom develops against the background of aortitis, aortic dissection, or malignant tumors of the mediastinum.The diagnostic complex includes radiography of the spinal column, 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 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, the discomfort in the back is insignificant, but it increases sharply when coughing, laughing, or when trying to talk loudly.The pain is dull in nature; burning and rawness in the interscapular area are less common.Symptoms last 3-7 days, disappearing without a trace after the inflammatory process subsides.

Posture disorders

Often the causes of pain between the shoulder blades are scoliosis, kyphosis or lordosis.Symptoms develop when sitting for a long time in an uncomfortable position, after sleeping on a too soft or, conversely, very hard mattress.Dull or aching pain appears, which intensifies when bending over or making sharp turns.Unpleasant sensations are observed already at a young age, which is 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 such cases, thoracic kyphosis intensifies, which is manifested by intense back pain and discomfort when staying in one position for a long time.As the disease progresses, adolescents feel a sharp pain between the shoulder blades, which 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 the nerve structures.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 primarily 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 decrease or disappear completely during the day.The pain subsides 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 on the back forms.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 determined between discomfort and food intake, physical activity with the body bending forward.Symptoms are supplemented by a retrosternal burning sensation, heartburn, and 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 finishing a meal.Manifestations intensify if the patient takes a lying position, bends over a lot and performs physical work.Frequent heartburn and sour belching are observed.
• Achalasia cardia.If there is a violation of the opening of the lower esophageal sphincter, sharp retrosternal and interscapular pain occurs at the moment of swallowing.At first, symptoms appear sporadically - when eating in a hurry, chewing food poorly and swallowing large pieces at once.Dysphagia then 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 sharp pain in the chest, the space between the shoulder blades.The patient feels that food is stuck in the middle of the esophagus, and swallowing movements do not help 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 mistaken for an attack of angina.Symptoms occur after eating, physical activity, and straining.To reduce discomfort, patients induce vomiting or belching and drink water.

Aortic pathologies

Back pain occurs with aortitis.Discomfortable sensations are localized between the shoulder blades, behind the sternum, sometimes they move to the neck or epigastric region.Less commonly, a painful burning sensation occurs in the chest and radiates to the back.Soreness is a constant concern and does not depend on the action of external factors.Typically, tachycardia, shortness of breath on exertion, at rest, and a dry hacking cough are detected.

Unbearable retrosternal pain, radiating to the interscapular area and spreading from top to bottom, is observed with dissecting aortic aneurysm.Sometimes the sensations are so strong that the patient loses consciousness from painful shock.Blood pressure drops, pulse quickens, oxygen starvation of the brain occurs.If a person is not given emergency medical care, there is a high risk of death.

Mediastinitis

Intense 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 back the head, and coughing.To reduce back pain and ease breathing, the patient sits with his head tilted forward, slightly hunched over.Edema and cyanosis of the upper half of the body develop, and subcutaneous emphysema occurs occasionally.

Acute inflammation of the mediastinum is accompanied by 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 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 into 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 when the esophagus is affected, puffiness and cyanosis of the face when the superior vena cava is compressed.

Rare causes

• Injuries: spinal fracture, spondylolisthesis, crack or fracture of the scapula.
• Muscle diseases: myalgia, myositis, muscular-tonic syndrome.
• Pulmonary diseases: pneumonia, dry or exudative pleurisy.

Diagnostics

The initial examination is carried out by an orthopedic traumatologist, who, after a physical examination, notices poor 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, 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 diagnosing thoracic osteochondrosis and helps 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 us to exclude pulmonary diseases as one of the causes of pain between the shoulder blades.X-ray imaging also shows widening 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 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 angioscanning.Ultrasound scanning of the aorta is used as a screening method for detecting inflammatory changes and aneurysms.To assess 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 the diagnostic search.Patients undergo a standard complex: hemogram, biochemical blood test, test for hepatitis and HIV infection.According to indications, a coagulogram is performed.In case of 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.If there are disorders 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, 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 correct 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

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 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 medications are used to treat the causes of pain:

• Nonsteroidal 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 for diseases of the respiratory organs and mediastinitis.
• Antisecretory drugs.Proton pump inhibitors and H2-histamine blockers are the basis for the treatment of GERD and achalasia cardia.The drugs reduce damage to the esophagus from acidic stomach contents and relieve pain.To quickly relieve the 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 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 get rid of the state of shock: for this purpose, cardiotropic medications, infusion solutions are used, and oxygen support is provided.To relieve pain, narcotic analgesics and tranquilizers are administered.

Non-drug methods play an important role in the treatment of musculoskeletal diseases.Special exercise therapy complexes are prescribed to strengthen the muscle corset and form an even posture.Manual manipulation, kinesiotherapy, 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 deformities of the spinal column, surgical correction of scoliosis is recommended.Surgical treatment for osteochondrosis is resorted to in the case of spinal compression: the 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 and severe stenosis of the esophagus.The hernial orifice is sutured with crurorrhaphy, 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 with reconstruction of the aorta.