Back pain between the shoulder blades

Back pain between the shoulder bladesoccurs in diseases of the spine (postural disorders, osteochondrosis, ankylosing spondylitis), diseases of the esophagus (gastroesophageal reflux disease, achalasia, strictures) and mediastinitis.Less commonly, the symptom develops against the background of aortitis, aortic dissection or malignant tumors of the mediastinum.The diagnostic complex includes X-rays of the spine, OGK, CT and MRI, as well as endoscopy.The condition of the vessels is assessed using ultrasound and aortography.Pain is relieved by prescribing NSAIDs or narcotic analgesics.The underlying disease is treated using medicinal, 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 pain in the back is insignificant, but increases sharply when coughing, laughing or trying to speak loudly.The pain is dull in nature;Burning and roughness in the interscapular area are less common.Symptoms last 3-7 days and disappear without a trace after the inflammatory process subsides.

Postural disorders

Scoliosis, kyphosis or lordosis are often the causes of pain between the shoulder blades.The symptoms appear when sitting in an uncomfortable position for a long time after sleeping on a mattress that is too soft or, conversely, very hard.Dull or aching pain occurs that increases when bending or turning sharply.Unpleasant sensations are observed from an early age, which is associated with the prevalence of posture disorders in children.

Similar signs occur in patients suffering from a certain juvenile pathology - Scheuermann-Mau disease.In such cases, thoracic kyphosis increases, which manifests itself in severe back pain and discomfort when remaining in one position for a long time.As the disease progresses, adolescents experience a stabbing pain between the shoulder blades that occurs in the evening.

Breast osteochondrosis

Patients with degenerative spine disease suffer from dull pain in the back between the shoulder blades, which occurs due to constant muscle tension and compression of nerve structures.The symptoms worsen when you turn or bend your body, or when you stand or sit for long periods of time.When pain is severe, a person's daily physical activity is limited.

Severe interscapular pain is observed with a herniated disc of the thoracic spine.If the upper chest segments are affected, the clinical picture is accompanied by numbness and tingling in the hands as well as difficulty swallowing.The pathology of the middle thoracic region is characterized by intercostal neuralgia, and when the lower thoracic vertebrae are damaged, severe pain is felt in the epigastrium and under the ribs.

Ankylosing spondylitis

An early sign of the disease is discomfort, especially in the lumbar spine.However, 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 subside or disappear completely throughout 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 forms on the back.A typical symptom of Bechterew's disease is sacroiliitis, an inflammation of the sacroiliac joint.

Diseases of the esophagus

Most diseases of the esophagus are characterized by pain radiating into the interscapular space.In this case, a clear connection is established between discomfort and food intake, physical activity with the body bent forward.The symptoms are accompanied by a retrosternal burning sensation, heartburn and acid regurgitation.Most commonly, back pain between the shoulder blades is caused by:

• GERD.A burning sensation behind the breastbone and in the back area 10-20 minutes after eating is typical of reflux esophagitis.The manifestations intensify when the patient takes a lying position, bends sharply and performs physical labor.Frequent heartburn and acid belching are observed.
• Achalasia cardia.When the opening of the lower esophageal sphincter is violated, sharp retrosternal and interscapular pain occurs at the moment of swallowing.Symptoms initially appear sporadically - with hasty eating, poor chewing of food and swallowing large pieces at once.Then the dysphagia becomes permanent.
• Esophageal stenosis.The narrowing of the lumen of the organ is accompanied by difficulties in the passage of the food bolus, which leads to severe 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 to move it further, but only increase the discomfort in the back.

Diaphragmatic hernia

It is characterized by severe pain that spreads throughout the upper abdomen and extends into the interscapular area.A hiatal hernia often also causes pain in the precordial area, which is mistakenly confused with an angina pectoris attack.Symptoms occur after eating, physical activity and exertion.To relieve the discomfort, patients induce vomiting or belching and drink water.

Aortic pathologies

Back pain occurs with aortitis.Unpleasant sensations are localized between the shoulder blades, behind the breastbone, and sometimes they also travel to the neck or stomach area.Less commonly, there is a painful burning sensation in the chest that radiates to the back.Pain is a constant problem and does not depend on the influence of external factors.Typically, tachycardia, shortness of breath on exertion, at rest, and a dry, tingling cough are noted.

With dissecting aortic aneurysm, unbearable retrosternal pain is observed, radiating to the interscapular region and spreading from top to bottom.Sometimes the sensations are so strong that the patient loses consciousness due to a painful shock.Blood pressure drops, the pulse quickens, and 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

Acute posterior mediastinitis is characterized by severe, sudden pain in the area between the shoulder blades.The symptoms worsen when swallowing, throwing back the head and coughing.To relieve back pain and make breathing easier, the patient sits with his head tilted forward and slightly bent forward.Edema and cyanosis of the upper half of the body develop, and occasionally subcutaneous emphysema 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, persistent low-grade fever and periodic difficulty swallowing are observed.

Mediastinal cancer

Pain in the retrosternal area radiating to the area between the scapulae 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.The excruciating pain syndrome is accompanied by shortness of breath and cough when the bronchi are affected, dysphagia when the esophagus is affected, swelling and cyanosis of the face when the superior vena cava is compressed.

Rare causes

• Injuries: Spinal fracture, spondylolisthesis, tear or fracture of the scapula.
• Muscle diseases: Myalgia, myositis, muscle tone syndrome.
• Lung diseases: Pneumonia, dry or exudative pleurisy.

diagnosis

The initial examination is carried out by an orthopedic traumatologist, who, after a physical examination, diagnoses 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 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 the diagnosis of thoracic osteochondrosis and helps to visualize post-traumatic bone changes.To detect an intervertebral fracture, the x-ray is supplemented by a CT or MRI of the spine.
• X-ray image of the OGK.The standard research method allows us to exclude lung disease as one of the causes of pain between the shoulder blades.X-rays also show 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 examines the condition of the mucous membrane of the organ.Biopsies are taken from suspicious areas for histological analysis.
• Ultrasound angioscanning.Ultrasound examination 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 a dissection 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.Depending on the indication, a coagulogram is carried out.In the case of a possible acute inflammatory process, data on acute phase indicators are informative.The HLA-B27 antigen is determined in patients with suspected Bechterew's disease.

Due to the variety of causes of interscapular pain, additional testing may be necessary.In the case of diseases of the upper respiratory tract, consultation with an ENT doctor 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, balanced diet without harmful foods, active lifestyle and 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

When treating back pain between the shoulder blades, a differentiated approach is used - the therapeutic regimen is selected individually, taking into account the underlying disease that caused the symptoms and concomitant diseases.In the case of orthopedic problems, the focus is on correcting posture with the help of corsets and other orthoses.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 bone and joint system, as well as to eliminate inflammation and accelerate recovery.NSAIDs are also effective for diseases of the respiratory system and mediastinitis.
• Antisecretory drugs.Proton pump inhibitors and H2 histamine blockers are the basis for the treatment of GERD and achalasia.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.In acute forms of mediastinitis, massive antimicrobial therapy is indicated to kill pathogens and prevent bacterial complications.Drugs are selected empirically.A combination of 2-3 active ingredients is introduced to act on all possible types of microbes.
• Cytostatics.For some forms of mediastinal cancer, polychemotherapy is used as preparation for surgery or as palliative treatment.Immunosuppressants are sometimes recommended for patients with severe forms of ankylosing spondylitis.

Patients with acute illnesses (aortic dissection, fulminant mediastinitis) are hospitalized in the intensive care unit.The aim of the treatment is to eliminate the state of shock: for this purpose, cardiotropic medications, infusion solutions are used and oxygen support is provided.Narcotic analgesics and sedatives are administered to relieve pain.

Non-drug methods play an important role in the treatment of musculoskeletal system diseases.To strengthen the muscle corset and achieve a uniform posture, special exercise therapy complexes are prescribed.Manual manipulation, exercise therapy, orthopedic chest, back and lumbar massage show good results.Various physiotherapeutic methods are used: electrical stimulation of the back muscles, peloid therapy, general UV radiation.

Surgical treatment

If the deformity of the spine persists, surgical correction of scoliosis is recommended.In case of spinal compression, surgical treatment of osteochondrosis is resorted to: the intervertebral hernia is removed and the spinal canal is decompressed.As a rule, minimally invasive techniques are used: puncture, vaporization of the intervertebral disc, microdiscectomy.

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