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, cardiac achalasia, stenoses), mediastinitis.More rarely, 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.Pain is relieved by prescribing NSAIDs or narcotic pain relievers.Treatment of the underlying disease is represented by medicinal, physiotherapeutic and surgical methods.

Causes of back pain between the shoulder blades

Respiratory diseases

Pain between the shoulder blades occurs with tracheitis or acute 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 trying to speak loudly.The pain is dull in nature;burning and irritation in the interscapular area are less common.The symptoms last 3 to 7 days and disappear without a trace once the inflammatory process has subsided.

Posture disorders

The causes of pain between the shoulder blades are often 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, very hard.A dull or aching pain appears, which intensifies when you bend or make sharp turns.Unpleasant sensations are observed from a very young age, associated with the prevalence 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 when staying in one position for a long time.As the disease progresses, adolescents feel 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, caused by constant muscle tension and compression of nerve structures.The discomfort becomes stronger when turning and bending the body, standing or sitting for long periods of time.When severe pain occurs, a person's daily physical activity is limited.

Severe interscapular pain is observed with a herniation 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 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 night, intensify in the morning and decrease or completely disappear 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.Thus, 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.

Esophageal diseases

Most esophageal pathologies are characterized by pain radiating into the interscapular space.In this case, a clear connection is determined between discomfort and food intake, physical activity with the body leaning forward.The symptoms are complemented by a retrosternal burning sensation, heartburn and acidic belching.Most often, back pain between the shoulder blades is caused by:

• GERD.With reflux esophagitis, a burning sensation behind the breastbone and in the back is typical 10 to 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 acidic belching are observed.
• Cardiac achalasia.In case of violation of the opening of the lower esophageal sphincter, acute retrosternal and interscapular pain occurs during swallowing.At first, symptoms appear sporadically - when you eat quickly, chew food poorly, and swallow large pieces at once.The dysphagia then becomes permanent.
• Esophageal stenosis.The narrowing of the lumen of the organ is accompanied by difficulties in passing the food bolus, which causes severe pain in the chest and the space between the shoulder blades.The patient has the impression that the food is stuck in the middle of the esophagus, and swallowing movements do not allow it to be moved further and only increase the discomfort felt in the back.

Diaphragmatic hernia

It is characterized by intense 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 attack of angina.Symptoms occur after eating, physical activity, and exertion.To reduce discomfort, patients induce vomiting or belching and drink water.

Aortic pathologies

Back pain occurs with aortitis.Uncomfortable sensations are localized between the shoulder blades, behind the sternum, sometimes they move to the neck or epigastric region.More rarely, a painful burning sensation appears in the chest and radiates towards 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 dry, dry cough are detected.

Unbearable retrosternal pain, radiating to the interscapular zone and spreading from top to bottom, is observed with a dissecting aortic aneurysm.Sometimes the sensations are so strong that the patient loses consciousness from painful shock.Blood pressure drops, pulse races, and the brain lacks oxygen.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 when swallowing, throwing back the head and coughing.To reduce back pain and make breathing easier, the patient sits with the head tilted forward, leaning slightly.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: dull and moderate pain is observed in the back, behind the sternum, prolonged low-grade fever and periodic swallowing disorders.

Mediastinal cancer

Pain in the retrosternal region, which radiates to the area between the shoulder blades, is the main complaint of patients with mediastinal malignancies.The symptom appears in an advanced stage of the disease and is caused by the growth of the tumor into nearby structures and nerve endings.Excruciating pain syndrome is accompanied by 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

• Injuries: vertebral fracture, spondylolisthesis, crack or fracture of the scapula.
• Muscle diseases: myalgia, myositis, musculo-tonic syndrome.
• Lung diseases: pneumonia, dry or exudative pleurisy.

Diagnosis

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 with 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:

• Spinal x-ray.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 an intervertebral hernia, the x-ray is supplemented by a CT scan or MRI of the spine.
• X-ray of the OGK.The standard research method allows us to exclude lung diseases as one of the causes of pain between the shoulder blades.Radiographic imaging also shows 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 permeability of the organ, the consistency 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 of the aorta is used as a screening method to detect inflammatory changes and aneurysms.To assess the condition of the thoracic region, transesophageal echocardiography is performed.The diagnosis of dissecting aneurysm is confirmed by a radiological 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, data on acute phase indicators are informative.In patients with suspected ankylosing spondylitis, the HLA-B27 antigen is determined.

Given the diversity of causes of interscapular pain, additional testing may be necessary.In case of upper respiratory tract disorders, a consultation with an otolaryngologist and a complete ENT examination are necessary.If a malignant tumor of the mediastinum is suspected, oncologists participate 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 diagnostic research, the doctor prescribes non-narcotic pain relievers, 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 causing the symptoms and concomitant pathologies.In the event of orthopedic problems, posture correction using corsets and other orthotics is emphasized.The following groups of drugs are used to treat the causes of pain:

• Non-steroidal anti-inflammatories.Prescribed to relieve discomfort associated with diseases of the osteoarticular system, as well as to eliminate inflammation and accelerate recovery.NSAIDs are also effective against diseases of the respiratory organs and mediastinitis.
• Antisecretory drugs.Proton pump inhibitors and histamine H2 blockers form the mainstay of treatment for GERD and cardiac achalasia.The medications 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 treatment is indicated in acute forms of mediastinitis in order 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.
• Cytostatic.Multi-chemotherapy is chosen for certain forms of mediastinal cancer in preparation for surgery or in 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 drugs, solutions for infusion are used and oxygen supply 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 a uniform posture.Manual manipulations, physiotherapy, orthopedic massages of the chest, back and lower back give good results.Many physiotherapeutic methods are used: electrical stimulation of the back muscles, peloid therapy, general ultraviolet radiation.

Surgical treatment

In cases of persistent spinal deformities, surgical correction of scoliosis is recommended.In the event of spinal compression, surgical treatment of osteochondrosis is used: the intervertebral hernia is removed and the spinal canal is decompressed.As a general rule, minimally invasive techniques are used: vapor puncture of the disc, microdiscectomy.

Surgical interventions are indicated for complicated forms of diaphragmatic hernia and severe esophageal stenosis.The hernia orifice is sutured by crurorrhaphy, gastropexy or fundoplication, resection and esophageal plasty.Emergency surgery is the only treatment for a dissecting aneurysm.Vascular surgeons perform a resection of the damaged area with reconstruction of the aorta.