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 spine, OGK, computed tomography and magnetic resonance imaging, 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 in acute tracheitis or bronchitis, when unpleasant sensations radiate from the chest to the back.At rest, back discomfort is negligible, but increases markedly when coughing, laughing or trying to speak loudly.The pain is of a dull nature;burning and rawness in the interscapular area are less common.Symptoms last from 3 to 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 mattress that is too soft or, conversely, too hard.A 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 posture disorders in 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 remaining in the same position for a long time.As the disease progresses, teenagers feel a sharp pain between the shoulder blades, which occurs at night.

Thoracic osteochondrosis

Patients with degenerative spine disease suffer from dull pain in the back, between the shoulder blades, caused by constant muscle tension and compression of nerve structures.The discomfort becomes more severe 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 seen with hernia of the 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 middle 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 particularly in the lumbar spine, but as ankylosing spondylitis progresses, symptoms spread to the back, between the shoulder blades.Unpleasant sensations develop in the afternoon or evening, intensify in the morning and decrease or disappear completely during the day.The pain subsides after a hot 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 constant and reduces the patient's motor activity.Over time, a characteristic bulge forms on the back.A typical symptom of ankylosing spondylitis is sacroiliitis, an inflammation of the sacroiliac joint.

Esophageal diseases

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 leaning forward.Symptoms are complemented by retrosternal burning sensation, heartburn and sour belching.Most often, back pain between the shoulder blades is caused by:

• GERD.With reflux esophagitis, a burning sensation behind the sternum and in the back area is typical 10-20 minutes after finishing a meal.The manifestations intensify if the patient lies down, 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, acute retrosternal and interscapular pain occurs at the time 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 organ's lumen is accompanied by difficulties in passing the food bolus, which causes severe pain 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 intense pain that spreads across the upper abdomen and moves to the interscapular region.Often, with a hiatal hernia, there is also pain in the precordial region, which is confused with an angina attack.Symptoms occur after eating, practicing physical activity and exertion.To reduce discomfort, patients induce vomiting or burping and drink water.

Aortic pathologies

Back pain occurs with aortitis.Uncomfortable sensations 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 on exertion, at rest and a dry cough are detected.

Unbearable retrosternal pain, radiating to the interscapular region and spreading from top to bottom, is seen in aortic aneurysm dissection.Sometimes the sensations are so strong that the patient loses consciousness due to painful shock.Blood pressure drops, the pulse quickens, there is a lack of oxygen in the brain.If a person does not receive emergency medical care, there is a high risk of death.

Mediastinitis

Severe pain that begins suddenly and is felt in the region between the shoulder blades is characteristic of acute posterior mediastinitis.Discomfort increases when swallowing, throwing the head back and coughing.To reduce back pain and facilitate breathing, the patient sits with the head tilted forward, slightly curved.Edema and cyanosis develop in the upper half of the body, and subcutaneous emphysema occasionally occurs.

Acute inflammation of the mediastinum is accompanied by massive intoxication, so the pain syndrome is accompanied by febrile fever, weakness and cardiac dysfunction.With 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 region 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 in neighboring structures and nerve endings.Excruciating pain syndrome is combined with shortness of breath and coughing 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

• Injuries: fracture of the spine, spondylolisthesis, fissure or fracture of the scapula.
• Muscle diseases: myalgia, myositis, musculotonic syndrome.
• Lung diseases: pneumonia, dry or exudative pleurisy.

Diagnosis

The initial examination is carried out by an orthopedic traumatologist, who, after physical examination, notices 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 diagnosing thoracic osteochondrosis and helps to visualize post-traumatic bone changes.To detect intervertebral hernia, radiography is supplemented with computed tomography or magnetic resonance imaging of the spine.
• OGK X-ray.The standard research method allows you to exclude lung diseases as one of the causes of pain between the shoulder blades.The x-ray 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 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 state of the mucous membrane of the organ.Biopsies are taken from suspicious areas for histological analysis.
• Ultrasound angioscanning.Aortic ultrasound is used as a screening method to detect inflammatory changes and aneurysms.To assess the state of the thoracic region, transesophageal echocardiography is performed.The diagnosis of dissecting aneurysm is confirmed by the radiographic method - aortography.
• Laboratory methods.They play a supporting role in the diagnostic search.Patients undergo a standard complex: blood count, biochemical blood test, test for hepatitis and HIV infection.According to indications, a coagulogram is performed.In the 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 necessary.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 absolute bed rest.

Conservative therapy

When treating 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 concomitant pathologies.In the case of orthopedic problems, postural 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 accelerate recovery.NSAIDs are also effective for diseases of the respiratory organs and mediastinitis.
• Antisecretory medications.Proton pump inhibitors and H2-histamine blockers are the mainstay for the treatment of GERD and achalasia cardia.The medications 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.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 admitted to the intensive care unit.The purpose of treatment is to get rid of the shock state: for this, cardiotropic drugs, 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 muscular corset and form an even posture.Manual manipulation, kinesiotherapy, orthopedic massage of the chest, back and lumbar region show good results.Various 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.Surgical treatment of 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: disc vaporization puncture, 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 injured area with reconstruction of the aorta.