Muscle pain in the scapula

Painful sensations in muscles, myalgia, as a symptomatic phenomenon has not been studied enough, especially pain in the muscles of the shoulder blade. Until now, muscle pain symptom is attributed either to vertebrogenic diseases or to neurological ones, that is, it is associated with radiculopathy, spondyloarthrosis, osteochondrosis, and so on.

Relatively recently, separate nosological units appeared in the classification of diseases - fibromyalgia and myalgia, which are directly related to muscle tissue. Despite the fact that soft tissue pathologies, including pain in the scapular muscles, have been studied since the 19th century, there is still no unity in terminology and systematization of syndromes. Obviously, this is due to the close anatomical relationship of soft (periarticular) tissues and bone structures in the back and in the human body in general. Back pathology can cover several nearby anatomical zones at once, such pain is usually called dorsalgia, but pain manifestations in the region scapularis (scapular zone) are more correctly and accurately called scapalgia.

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Causes of Shoulder Blade Muscle Pain

Unlike other muscle syndromes, the causes of pain in the muscles of the shoulder blade are most often not related to the "culprit" of all spinal pain - osteochondrosis. This is due to the low mobility and fairly strong structure of the thoracic spine. Consequently, almost all painful sensations in the shoulder blade area are associated with muscle tissue, as well as damage to the tendons, supraspinous ligaments.

The main cause of aching pain in the middle of the back is explained by prolonged muscle tension, usually due to the specifics of professional activity. First of all, this concerns those who maintain the same position for a long time, often sitting - drivers, office workers, seamstresses, students and so on. Accumulating, tension in the shoulders and in the shoulder blade area leads to compensatory shortening, contraction of the pectoral muscles, the condition is aggravated by the habit of slouching, stretching the head, neck forward. As a result, the muscles that lift the scapulae, part of the trapezius muscle, sternoclavicular, deltoid are overstrained, and others located in the middle of the back - the lower part of the trapezius, flexors of the neck, anterior serratus are subject to compensatory stretching or weakening, all these abnormal, non-physiological phenomena provoke pain.

Also in clinical practice, the causes of pain in the muscles of the scapula are classified according to the types of muscle-tonic syndromes:

1. Chest muscle syndrome (minor pectoral muscle) or ladder syndrome. Pain in the shoulder blade area appears on the line of the 3rd-5th rib, is felt as burning, aching. The symptom may intensify at night, during body movement, when abducting the arms (hyperabduction). Often, such manifestations resemble attacks of angina, which significantly complicates diagnosis. In addition, chronic hypertonicity of the minor pectoral muscle leads to pinching of the nerve and vascular plexus, a bundle located near the coracoid process of the scapula, as a consequence - loss of sensitivity of the hand, fingers. Pain in chest muscle syndrome is localized in the anterior deltoid zone, between the shoulder blades, transmitted along the ulnar (ulnar) surface of the shoulder and forearm.
2. Syndrome m. serratus posterior superior - the upper posterior serratus muscle is often provoked by a degenerative process in the upper thoracic intervertebral discs. The pain is localized under the shoulder blade, felt deep in the muscles, has a dull, aching character.
3. Syndrome m. serratus posterior inferior - the lower posterior serratus muscle is felt as a chronic, debilitating dull pain in the lower back (at the level of the chest). The syndrome limits body movements when bending, rotating.
4. Interscapular syndrome is felt as aching, aching pain between the shoulder blades. The symptom intensifies with prolonged horizontal position of the body, with bends, the pain can become quite strong when traveling on rough terrain (vibration). The pain is localized in the place of attachment of the rhomboid, trapezius and latissimus dorsi muscles (area of the spine of the scapula), it can spread to the shoulder, forearm along the ulnar nerve.
5. Acquired winged scapula syndrome, which causes paralysis of the serratus anterior, trapezius, or rhomboid muscles. Paralysis can be caused by an infectious disease, trauma, or bruise, including professional ones (athletes, circus performers).

In addition, pain in the muscles of the shoulder blade can be caused by an inflammatory process in muscle tissue - myositis. Myositis, in turn, is provoked by the following factors:

1. Hypothermia.
2. Infections, including viral ones.
3. Occupational diseases associated with muscle hypertonicity.
4. Back injuries.

Quite often, pain symptoms in the shoulder blade area are poorly differentiated by sensations, so it is difficult to determine what actually hurts - muscles, bone tissue, tendons, or is this symptom reflected pain indicating possible pathologies, such as the following:

• IHD – ischemic heart disease.
• Angina pectoris.
• Myocardial infarction.
• Protrusion or herniation of intervertebral discs of the thoracic spine.
• Kyphoscoliosis.
• Intercostal neuralgia.
• Spondyloarthrosis.
• GU – gastric ulcer.
• Respiratory diseases – pneumonia, pleurisy.

In order to correctly determine the causes of pain in the shoulder blade muscles, it is necessary to describe the characteristics of the symptom as accurately as possible.

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How does pain in the shoulder blade muscles manifest itself?

Symptoms of muscle pain are characterized by sensations of tension and stretching. Unlike aching joint pain, symptoms of pain in the muscles of the scapula are often aching. Although the interscapular muscles, located between the spinous processes, can hurt quite intensely, similar to joints. If the patient complains of persistent pain in the area of the scapula, radiating to the left, not subsiding when changing body position, accompanied by a feeling of cold in the back, most likely this is evidence of damage not only to muscle tissue, but also to tendons and ligaments.

The nature of pain in the shoulder blade area may vary, depending on the source of the pain signal and the cause that provokes it: Parameters by which symptoms of pain in the shoulder blade muscles are differentiated:

• Description of sensation: sharp, aching, stabbing, squeezing, breaking pain.
• Localization of pain: between the shoulder blades, under them, under the right or left, at the top of the shoulder blades.
• Duration of pain – transient, long-term, chronic.
• Dependence on body position - subsides with a change in position, intensifies with certain movements.
• Distribution by type – visceral (reflected), neuropathic or only muscle pain.

How to distinguish between types of muscle pain in the shoulder blade?

Symptom	Muscular	Reflex, visceral	Neuropathic
Description	Precise description, including indication of localization	The description is vague, the pain is diffuse, comes from within, from deep within to the muscles	The pain spreads in the direction of the nerve roots, radiates
Are there any restrictions on movement?	Often limits physical activity	Movements are not limited	Limb movements are slightly limited, restrictions apply to the range of motion of the chest and back
The Effect of Movement on Pain	The pain increases with movement	Doesn't have any effect	Only axial load has an effect, as well as reflex movements - coughing, sneezing
Determination by palpation	Spasmodic areas are palpated well. Palpation aggravates the pain	The source of the symptom cannot be identified by palpation.	Possible definition

Muscle pain under the shoulder blade

Pain in the muscles under the shoulder blade can be both a sign of true myalgia and a signal of more dangerous diseases, such as:

• Gastric ulcer, which is most often localized in the epigastric area, but can radiate to the left side - to the chest area, under the left shoulder blade. The pain is not differentiated by structural type, it is difficult to determine what exactly hurts - muscles, ribs. Therefore, if the pain under the shoulder blade is associated with food intake, most likely it is caused by a disease of the gastrointestinal tract.
• An attack of angina often resembles the symptoms of muscle pain under the shoulder blade. It is difficult to differentiate these two symptoms independently, however, with angina, the pain subsides after taking vasodilators, muscle pain is not neutralized by these drugs.
• Intercostal neuralgia can also manifest itself as paroxysmal, encircling pains in the lower part of the scapular area. The pain intensifies when coughing, sneezing, and painful areas are easily determined by palpation.
• Muscle spasm of the gallbladder, blockage of the bile ducts often manifests itself in the form of colic, and the pain can be sharp, cutting in nature, radiating to the right upper part of the body, under the shoulder and right shoulder blade.

In any case, a simple pain symptom that a person considers muscular should pass without specific treatment within 1-2 days at most. Rest and relaxation are enough to relax the muscles, if the pain under the shoulder blades does not subside, you must urgently seek medical help.

Diagnosis of pain in the muscles of the shoulder blade

The task of diagnostic measures in determining the cause of muscle pain in the shoulder blade area is, first of all, to exclude possible life-threatening pathologies - angina attack, myocardial infarction, perforation of gastric ulcer and such diseases:

• Oncological processes in the spinal column.
• Oncologic processes in internal organs.
• Neurological pathologies requiring urgent therapy.
• Psychogenic factors, diseases, including psychopathologies.

This is due to the fact that the diagnosis of pain in the muscles of the scapula is difficult due to the non-specificity of the symptoms, the clinical picture rarely indicates a specific diagnostic direction, in addition, almost all dorsalgias rarely correlate with the results of instrumental examinations. Quite often there are cases when there is a pain symptom, but the examination does not reveal a single reliable pathological source of pain, it also happens that studies determine a pathology that is not accompanied by a clearly expressed clinical sign.

Typically, diagnosing shoulder blade muscle pain involves the following steps:

• A brief anamnesis and a detailed description of the background of the symptom are not required, since the painful muscle symptom is not considered pathognomic for a dangerous, threatening pathology.
• Clarification of the nature and parameters of pain:
  • Localization, possible irradiation.
  • In what position or body position does pain appear?
  • What time of day does the pain bother you?
  • Relationship of the symptom with motor activity and other factors.
  • The rate of symptom development – spontaneous or increasing pain.
• Visual examination of the patient:
  • Asymmetry of the shoulder-scapular region.
  • Detection of possible scoliosis, spinal anomalies (Forestier's test symptom).
  • Mobility of the thoracic spine (Ott's test symptom, Thomayer's symptom).
  • Determination of possible pain along the spinous processes (Zatsepin's symptom, Vershchakovsky's test, bell symptom).
• Instrumental examination is usually not required, since muscle pain is considered benign in 95% of cases. Research is only needed in cases of suspected pathologies:
  • Signs of an acute infectious process.
  • Signs of oncology.
  • Obvious neurological symptoms.
  • Injury.
  • Ineffective treatment for a month.
  • X-rays are also necessary if the patient is referred for manual therapy or physiotherapy procedures.
• Electromyography may be ordered to determine the characteristics of muscle structure.

It should be noted that the widely used practice of referring a patient with muscle pain for an X-ray can significantly complicate the diagnosis, since the vast majority of our contemporaries have some signs of osteochondrosis and other diseases of the spine. The presence of a degenerative process in the spinal column itself does not exclude a myogenic factor that provokes pain in the muscles of the scapula and cannot be the basis for a correct diagnosis.

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Treatment of shoulder blade muscle pain

Treatment of pain in the muscles of the shoulder blade can be divided into two stages: short-term, emergency measures and long-term tactics.

Urgent measures	Long-term activities
Neutralization of pain symptoms with analgesics or non-steroidal anti-inflammatory drugs	Preventing the causes of muscle pain
Prescribing muscle relaxants	Gentle stretching or dynamic exercises
Injection or acupuncture effect on TP (trigger points)	Exercises aimed at correcting posture
Relief, neutralization of comorbid symptom complexes	Correction of professional workload
	Normalization and maintenance of weight
	Psychocorrection of pain symptoms
	Compliance with the rules of a healthy lifestyle, including physical activity

In general, treating muscle pain is not difficult, as a rule, it is enough to give rest to overstrained muscles, to exclude factors that provoke the symptom. Massage and training in relaxation methods, including post-isometric relaxation, also give good results.

How to prevent shoulder blade muscle pain?

How to prevent muscle pain, wherever it develops, in the back, in the shoulder blade area, lower back, neck? Obviously, there are no specific recommendations, because each human body is individual in its anatomical structure, physiological and other parameters. However, prevention of pain in the shoulder blade muscles is the observance of well-known, but, unfortunately, rarely used in practice measures. These rules concern primarily the following points:

1. If a person is undergoing treatment for muscle or other pain, illness, it is necessary to strictly follow and fulfill all doctor's orders. Self-medication is an extremely common phenomenon, but the percentage of effectiveness it gives is minimal, in contrast to the huge number of complications.
2. After completing a course of treatment for muscle pain, you need to maintain a gentle motor regime, but this does not mean complete rest and inactivity. Muscles need to be trained, otherwise the opposite effect of hypertonus will occur - adynamia, atrophy and weakness of the muscle structure.
3. Regular exercise is a good way to maintain muscle tone, even if a person is not involved in professional sports; simple morning exercises can easily replace complex workouts.
4. All factors that provoke static tension should be excluded. If a person's professional activity is associated with constant overstrain of the shoulder blade muscles, it is necessary to regularly change the body position during the working day. do warm-ups.
5. To maintain muscle tone and relieve the spine, you need to monitor your posture and, if necessary, wear a corrective corset.

Shoulder blade muscle pain is a rather complex polyetiological symptom, and not an independent disease. Only a doctor can determine the exact cause of the pain, conduct all the necessary examinations and prescribe effective treatment. The person experiencing discomfort in the shoulder blade area is only required to take care of their health and seek help in a timely manner at the first alarming signs.