Pain under the left shoulder blade

Pain under the left shoulder blade, not being the only, specific symptom in the clinical sense, is one of the symptoms that may indicate various diseases. Timely and accurate assessment of the nature of pain, its localization helps the doctor to choose the right direction for diagnostic examinations and provide assistance, often urgent in cases of cardiac or gastrointestinal pathologies.

Causes of pain under the left shoulder blade

Pain in the area of the left shoulder blade can be caused by the main cause - a disease of the spine, in addition, pain under the left shoulder blade can be a secondary symptom of injury or pathological processes that develop in internal organs and systems.

The summary list of causes of pain under the left shoulder blade is as follows: 

• Diseases of the musculoskeletal system: 
  • Osteochondrosis of the thoracic or cervical spine.
  • Traumatic injury of the scapula (compression damage to the supra-scapular nerve).
  • Mejrebernaya neuralgia.
  • Rib fracture.
  • Sprengel disease (scapula alata) - pterygoid scapula.
  • Myofascial syndrome.
• Diseases of the broncho-pulmonary system: 
  • Left-sided pneumonia.
  • Pleurisy (dry, left-sided).
  • Tracheobronchitis with autonomic dysfunction.
  • Acute bronchitis.
  • Abscess of the left lung.
• Heart disease:
  • Coronary artery disease - ischemic heart disease.
  • Myocardial infarction.
  • Pericarditis.
  • Angina (unstable, stable).
  • Prolapse of the mitral valve.
  • More rarely - an aortic aneurysm.
• Diseases of the gastrointestinal tract: 
  • YABZH (Ulcus gastrica) - peptic ulcer of the stomach.
  • Ulcus duodeni - duodenal ulcer.
  • Spasm of the esophagus.
  • GERD - gas-esophageal reflux disease.
  • Rarely - exacerbation of pancreatitis.
• Psychogenic factor provoking the IRR - vegetative-vascular dystonia with reflected pain in the left side of the back.

The typical causes of pain under the left shoulder blade are as follows: 

• Cervical osteochondrosis, which manifests itself most often as unilateral pain at the bottom os occipitale - occipital bone. The pain is aching in nature, increases with active movements of the head and constantly radiates under the scapula, into the arm. Also, osteochondrosis of the cervical spine is accompanied by dizziness, numbness, paresthesia in the upper extremities.
• Intercostal neuralgia, which develops as a result of osteochondrosis or for other reasons. Neuralgia is manifested by lumbago, severe pains of the surrounding character radiating to the right or left, often under the scapula.

YABZH (peptic ulcer). The symptom is most often caused by seasonality, depends on the food factor and is characterized by paroxysmal, radiating pain, which in clinical practice is classified as follows:

• A hungry pain symptom that develops after a long period after eating (6-8 hours).
• An early pain symptom that develops immediately after eating can be reflected in the back, under the scapula and subsides after the contents of the stomach are evacuated.
• Late pain symptom that occurs 2-3 hours after eating.
• Night symptom, which is characterized by pains radiating to the scapula.

The pains of YABZH may subside after vomiting or taking medicines. 

Perforation of the ulcer (perforation), accompanied by sharp, shooting, cramping pains, giving to the collarbone, under the scapula. Perforated ulcer is a condition that requires urgent medical measures, at the slightest suspicion of it, you should call for medical assistance, or try to get to the hospital yourself. 

Neurological pain associated with myofascial syndrome or vegetative-vascular dystonia. These symptoms are very similar to cardialgia, but they are not manifested in instrumental, hardware studies of deviations in the work of the heart. Similar conditions with pains of oppressive nature that extend into the arm, in the back, are removed by sedatives, tranquilizers. 

Myocardial infarction is a life-threatening condition that manifests itself most often with paroxysmal chest pains radiating to the arm, to the left side of the jaw, to the left side of the neck, and under the scapula. The pain is felt as pressing, compressing the heart. Symptoms require emergency care and immediate hospitalization. 

Аneurysma dissecans - stratifying aortic aneurysm, manifested by a sharp pain in the chest, radiating to the left side of the back, under the scapula, into the arm.

Symptoms of pain under the left shoulder blade

Signs, symptoms of pain in the lower region of the scapula are due to such pathogenetic mechanisms:

1. Girdle pains with localization in one side. This sign is permanent, less often - paroxysmal, the pain may increase with deep breathing, shortness of breath, coughing, with movements. The symptom is due to the spread of pain impulse along the intercostal muscle gaps, aponeurosis.
2. Burning pains with paresthesias, due to the transmission of impulses according to the location of the nerve trunk, nerve branches. The pains are reflected in the region of the heart, in the back, in the lower back or under the scapula.
3. Increasing pain, radiating under the scapula, in the arm, associated with hypertonicity of the muscles of the shoulder, shoulder blade, back.

The painful symptom under the left shoulder blade can vary in sensation from aching, tolerant to sharp, burning, cutting. There are some typical complaints of pain under the left shoulder blade on the part of patients: 

• Acute pain in the left back under the scapula, pain sensation increases with turns, movement and subsides at rest.
• Cutting sensation to the left, passing into the zone between the shoulder blades.
• Dull, aching pain below the scapula on the left, felt when the arm (s) rises. Pain is associated with a particular position of the body.
• Pulling sensation of pain, the symptom extends below the left shoulder blade to the lower back. The pain is permanent, it is not stopped by cardiac drugs.
• Sharp, pain reflected to the left, subsiding after nausea and vomiting.
• Constant pain under the scapula, which does not go away even in a resting state, the sensation of pain may increase and cause a burning sensation.
• The pain increases with a deep breath or cough, passes in a reclining position, with the head elevated.

Symptoms, manifestations of pain under the scapula on the left can be combined according to etiological signs as follows:

Cardiological diseases: ischemic heart disease, myocardial infarction, angina	The pain begins in the chest region (less often in the middle of the back) and is reflected in the left side - arm, jaw, under the scapula, back. The pain is overflowing in nature, causes a feeling of constriction, burning
Аneurysma dissecans - aortic aneurysm	Pain symptom is characterized as a constant, increasing, accompanied by sharp, shooting sensations left in the back, under the scapula. Pain develops very quickly and is a life-threatening symptom.
Recurrence of pericarditis	Reflected in the left side of the pain, subsiding at rest, in a sitting position, when bending forward
Pleuritis is a pleura	Sharp, stabbing pain symptom, the intensity of which depends on the depth of breathing. The pain can be felt as a tingling under the scapula, with a deep breath - as cutting, strong, penetrating.
Left pneumonia	The pain is not intense, aching, transient, may increase with movements, deep breathing, pain is reflected under the scapula as a localized "point"
Cervical osteochondrosis	The aching, nagging pain, which increases in statics or after exercise, the painful symptom can be reflected to the left, including under the scapula. Pain, unlike cardialgia, is not relieved by heart medication.
Ulcerative processes in the gastrointestinal tract	The pain is intense, often intolerable. When perforation in the cardiac area of the stomach - the pain is reflected to the left in the upper back. Pain symptom at the initial stage of the process subsides after vomiting

Left pain under the shoulder blade

The pain on the left in the lower region of the scapula may be associated with such diseases: 

• Ulcerative process in the gastrointestinal tract. As a rule, the pain symptom increases - with a chronic disease gradually, with exacerbation or perforation - rapidly. The pain surrounding, shooting, reflected can abate after the food is evacuated in intestines or by means of vomiting.
• Neurogenic pain, IRR (vegetative-vascular dystonia). The painful symptom is felt as squeezing, pressing, extending to the left, often under the scapula. Violations of respiratory functions, increased sweating, hand tremor, feeling of spasm, coma in the throat, feeling of fear, panic are also characteristic of the IRR.
• The pain on the left under the scapula may be associated with a developing myocardial infarction, which is often felt as another attack of IHD, angina pectoris. A pain symptom, as a rule, begins to develop in the chest zone, less often from the back, radiating to the left side, “spilling over” and causing a burning sensation.
• Cervical osteochondrosis, less often osteochondrosis of the thoracic region. This disease is accompanied by a characteristic aching, but tolerable pain symptom, which can intensify with increasing load, including static.

It should be noted that for an accurate clinical picture it is very important to describe the sensations, the nature of the painful symptoms, which may be the following:

The pain gives under the left shoulder blade.

The description of this symptom is a typical characteristic of the radiating pain, the pathological source of which can be located quite far from the place of pain. The pain gives under the left shoulder blade most often with diseases of the stomach and heart. Cardiac zone of the stomach, undergoing inflammatory or erosive process, often manifests itself as pain reflected to the left. For an experienced physician it is not difficult to accurately determine the primary source of pain according to the diagnostic scheme of Zakharyin-Gedd or Gaava-Luvsan. These methods are designed to differentiate the clinical signs of reflected pain according to the specific transmission of impulses along the vegetative path of the nervous system to symptomatic zones.

Burning under the shoulder blade

This is a signal of developed intercostal neuralgia, a prolonged deforming process in the spine. However, the most characteristic feeling of burning pain for an attack of angina and a more serious, life-threatening condition - myocardial infarction. The feeling of pressure, burning under the shoulder blade of the left, not stopped by heart medications is a reason to call emergency medical care, especially if the symptom is accompanied by pain in the lower jaw, neck, back, shortness of breath, cyanosis (pallor) of the skin. In addition, a burning sensation under the scapula, on the left side, may be evidence of a psychogenic disease - vegetative-vascular dystonia, when in addition to a painful symptom a person feels a strong feeling of fear, a hand tremor appears, tachycardia, a lump in the throat.

Constant pain under the left shoulder blade

It may be a signal of developing left-sided pneumonia, dry pleurisy. Such pain is not specific, however, if it increases with deep breathing, sneezing or coughing, the condition of the bronchopulmonary system should be examined as soon as possible. Constant pain under the left shoulder blade caused by pneumonia can subside in a horizontal position when turning the body to the healthy side. In addition, a constant reflected pain symptom is a typical sign of osteochondrosis of the cervical, less often the thoracic spine. The painful sensations are chronic, but they can increase like a pulmonary symptomatology with paroxysmally, with coughing, active movements, and deep breathing. Differentiate permanent left-side pains can only be a doctor with the help of x-rays of the lungs, spinal column.

The pain under the left shoulder blade and cough indicate a possible left-sided inflammation of the lung, which is also manifested by the following symptoms:

• Dry, less wet cough. The most specific sign, in addition to pain under the left shoulder blade, is the presence of impurities of pus or blood in the sputum. Even single discharge of this kind should be a reason for immediate examination and the start of treatment.
• Low-grade body temperature, which rarely rises. Hyperthermia is characteristic of the acute stage of pneumonia.
• Pain radiating towards the damaged lung. A painful symptom increases with deep breath, frequent breathing, exertion, cough. Lung tissue is not equipped with pain receptors, they are only in the pleura, so any painful pulmonary symptom can be considered a sign of pleurisy. It is necessary to differentiate such symptoms with a possible deforming process in the cervical spine.
• Dyspnea sensation, lack of air, shallow breathing.

Stabbing pain under left shoulder blade

The so-called lumbago, giving to the right or left - a typical sign of osteochondrosis, but the stabbing pain under the left shoulder blade may be a symptom of intercostal neuralgia, not associated with spinal deformity. Neuropathy is characterized by a tingling sensation, tension, often burning, subsiding when changing body postures, relaxing or warming muscles. In addition, a tingling in the back can indicate a developing pneumonia or pleurisy, such a stabbing symptom appears when coughing, taking a deep breath, or exercising, requiring intense breathing (running, walking).

The pain behind the left shoulder blade is a painful symptom localized in the back. In clinical practice, such manifestations are called scapular-rib thorakalgia, or vertebral pain. Differentiate the pain under the left shoulder blade from the back of the cardiac states in this way:

Symptom	Coronary heart disease (cardialgia)	Vertebral pain
Pain description	Pressing, compressing, most often in the chest zone, with reflection to the left. Accompanied by a sense of fear	Stitching, pressing, burning without anxiety, tachycardia
Frequency of pain	Short-term, paroxysmal (several minutes, rarely up to half an hour)	Rarely - short-term, often one that lasts several hours, maybe days.
Changing body position	No effect on pain	Affects, may increase or minimize pain symptom
Effect of exercise	Affects pain alone can subside	The pain can persist even at rest, and after physical exertion, subside, as a change in static muscle tension occurs.
Influence of drugs	The pain is relieved by heart medications.	The pain is relieved by antispasmodics, analgesics. Nitrates (cardiac drugs) do not affect the nature of pain
Impact of manual therapy	Virtually no effect	Significant relief due to release of squeezed nerve roots

The pain under the left shoulder blade is not considered to be a specific, specific symptom, therefore, the diagnosis of this symptom requires a comprehensive examination, possibly from several specialists.

Pressing pain under the left shoulder blade

This is a sign of developing osteochondrosis, a possible onset of an attack of IHD, as well as evidence of exacerbation of vegetative-vascular dystonia. Pressing pain under the left shoulder blade, which feels like bursting, burning, requires immediate medical attention and relief of the attack, as it is most likely associated with angina pectoris or a pre-infarction condition. Pressing pain under the left shoulder blade may also indicate a vegetative-vascular crisis, which is very similar in symptomatology to cardiac pain, but it does not stop with heart drugs, but is susceptible to sedatives or tranquilizers. Also for the IRR is characterized by the absence of a causal relationship between pain and physical activity, the load, while coronary artery disease may be aggravated by overstrain, intensive work.

Throbbing pain under the left shoulder blade

This is most likely a manifestation of left-sided protrusion of the intervertebral disk of the cervical or sternal spine. In addition, the herniation of intervertebral discs manifests itself as a pulsating pain under the left shoulder blade, it is accompanied by headache, unstable arterial pressure, dizziness, paresthesia of the left hand. It can also hurt the left shoulder, the entire left half of the back to the waist. Protrusions are detected by MRI, radiography. Pulsation below the scapula may be a symptom of incipient aortic dissection. Aortic aneurysm is a life-threatening condition, its rupture requires almost instant medical care, which is not always possible, therefore any reflected, throbbing back pain in the area of the shoulder blades should be a reason for a comprehensive examination and neutralization of the underlying cause of the symptom.

Sudden pain under the left shoulder blade

May be related to compression,. Damage to the suprascapular nerve. Such a trauma is manifested by a sudden sudden pain in the lower scapula, a pain symptom can spread to the shoulder and reduce the motor functions of the arm. Also, the sudden pain under the left scapula testifies to radiculopathy, in which the nerve roots are infringed upon the left-sided displacement of the intervertebral discs of the cervical spine, less often than the thoracic spine. This is a secondary symptom, which is a consequence of chronic pressure on the nerve endings with osteophytes, hernia, articular tissue. A long degenerative process, as a rule, is accompanied by aching constant pain, however, a sudden exacerbation may be caused by protrusion of an intervertebral hernia or severe edema in the area of displacement. Very rarely, sudden pain in the left shoulder blade can be a symptom of a collapsed left lung (pneumothorax). Such cases in clinical practice are not common, but sudden, sharp pains with shortness of breath and dizziness - this is a reason to cause emergency care.

Acute pain under the left shoulder blade.

It may signal an attack of angina pectoris, which “starts” from the chest zone and manifests itself in spilling pains reflected in the left side. The pain in angina pectoris is characterized as sharp, squeezing, compressive, the symptom may subside at rest and after taking certain drugs - validol, nitroglycerin, other drugs that activate the coronary blood supply. In addition, acute pain under the left shoulder blade can be caused by left-sided protrusion of the intervertebral disk, the symptom is aggravated by movement, change of body position, that is, when the position of the spine or ribs changes. The most dangerous is severe, acute pain in this zone, caused by perforation of the cardial region of the stomach during peptic ulcer disease. This condition is accompanied by a drop in blood pressure, pulse (vagal pulse), and perspiration. The pain is so acute that it is called “dagger”, most often it begins in the epigastric zone and gives to the left or right, depending on where the perforation occurs. Also for a YABZH in an aggravation stage the typical pose of the patient is characteristic - the drawn-in legs, the hands covering a stomach. Irradiation to the left, under the scapula, is characteristic of atypical perforation, when the ulcerative process is localized in the posterior part of the duodenal wall or in the cardiac zone of the stomach.

Aching pain under the left shoulder blade

The aching nature of pain speaks of a chronic, protracted process that provokes a symptom. Most often, aching pain is associated with osteochondrosis of the cervical spine, as well as with chronic heart diseases - myocarditis, pericarditis. The aching pain under the left shoulder blade during inflammation of the heart muscle (myocarditis) is unstable, it can be triggered by overstrain, fatigue, stress, and is accompanied by shortness of breath, pale skin, general poor condition, nausea. For pericarditis is characterized by increased pain and a clear localization on the left, radiating to the arm, in the back, under the scapula. The pain caused by a deforming spinal column can be varied - from aching, pressing, to shooting and again subsiding. However, the tolerable, dull character of pain is one of the main signs of cervical osteochondrosis in the initial stage of development.

Dull pain under the left shoulder blade

Most often associated with developing cervical or thoracic osteochondrosis. The onset of the disease is characterized by implicit, weak, radiating to the side of the infringement of the roots, pain. The pulling, periodically subsiding sensations in the initial period do not disturb the person very much, because they are quite tolerant, besides, the pain can go away after warming up, massage, bathing in a warm bath. Often, dull pain under the left shoulder blade gradually begins to become familiar, especially clearly it is felt after sleep, in the morning, or before going to bed after long sedentary work or work that requires uniform static voltage. The pain spreads from the nape down to the arm, along the back, under the scapula, often accompanied by dizziness, nausea, paresthesias (numbness, tingling) in the hands.

Severe pain under the left shoulder blade.

This is a reason to immediately consult a doctor, because an intense pain signal is not characteristic of the scapular zone, therefore, is associated with a serious, possibly threatening condition. At best, severe pain under the left shoulder blade may signal intercostal neuralgia, however, a peptic ulcer or a pre-infarction condition or a heart attack can be a more disturbing cause. In a situation where the symptom is associated with gastric ulcer (peptic ulcer), the person experiences so much pain that he cannot move, pressing his arm or leg to the diseased area. Irradiating to the left, penetrating a painful symptom can serve as a direction in the diagnostic sense, since such manifestations are characteristic of an ulcer in the cardiac zone of the stomach. Severe pain under the left shoulder blade may also indicate that an angina attack goes into the pre-infarction stage, especially when it is not stopped by heart medications. In addition to a strong painful sensation, a person feels a spreading, burning sensation, perhaps pressure with a reflection in the left side - in the arm, in the neck, under the scapula.

Sharp pain under the left shoulder blade

It may be a sign of intercostal neuralgia, in which case neuropathy increases with palpation of the painful area, with a deep breath, when there is a feeling that the breath "intercepts". Irritation of the nerve endings, the roots can be permanent, but most often episodic sharp pains are typical of neuralgia, the intensity of which subsides at rest or after warming up, relaxing the painful area. Also, a sharp pain under the left shoulder blade is characteristic of left-sided pneumonia in the acute period, when the patient feels stabbing, cutting symptoms in all of the left half of the chest, reflected under the shoulder blade. Pneumonia in the acute stage is accompanied by coughing, which aggravates the pain, and discharge of pus or blood is also possible in the sputum. Much less often in the left side of the back, in the area of the scapula, pain is reflected during exacerbation of pancreatitis, which is characterized by encircling, cramping pains.

Pulling pain under left shoulder blade

Most often associated with the conductivity of pain impulses along the intercostal nerves and is caused by cervical osteochondrosis in the initial stage of development. Constant compression of the nerve roots provokes tolerant, aching, nagging painful sensations below the occipital bone, which can be reflected in the left or right back, hands. The pain can develop and intensify, if the load on the cervical area increases or does not decrease, this symptom is typical for people performing work in a monotonous pose - sitting, standing. In addition, pulling pain under the left shoulder blade can be felt in the morning, when the body position also provokes a load on the muscle and nervous tissue in the cervical spine.

Diagnosis of pain under the left shoulder blade

Differentiation of symptoms in left-sided thoracalgia is extremely difficult, since pain is not specific and can be a sign of many diseases and conditions, including those requiring emergency medical care. Diagnosis of pain under the left shoulder blade requires complex measures, multiple examinations, but its main task is to eliminate threatening conditions such as gastric ulcer (ulcer of the stomach), angina, pre-infarction and heart attack, rupture of a dissected aorta. In order to accurately determine the cause of the symptom, the diagnosis of pain under the left shoulder blade should include the following actions:

• Survey and collection of anamnesis, including hereditary and professional. The patient is found out how the pain symptom is associated with food intake, with physical, static, emotional stress, where the pain radiates, as it is felt.
• Direct visual inspection, audition and palpation. Also mandatory is the measurement of heart rate, blood pressure, possibly body temperature.
• X-ray examinations are appointed, often in several projections to clarify the nature of possible pathologies of the spinal column or the pulmonary system.
• An electrocardiogram, which shows the parameters of the heart.
• Perhaps the appointment of CT, MRI. Computed tomography is a method that helps to specify a disease that is not detected by X-ray.
• If you suspect gastritis, gastroesophageal reflux, YABZH may assign fibrogastroduodenoskopii - FEGDS.
• OAK - complete blood count and urinalysis, possibly serum biochemical analysis, are standard diagnostic methods for almost any disease.

Pain treatment under the left shoulder blade

Therapeutic appointments for left-sided thoracalgia, pains at the bottom of the scapula directly depend on the diagnostic results. The primary treatment of pain under the left shoulder blade can only be associated with the relief of an acute, life-threatening condition. If a person suffers from chronic coronary artery disease, taking heart drugs will help relieve the first painful sensations. If the pain does not subside within 5-10 minutes, you should call an ambulance. Acute pain caused by gastric ulcer, osteochondrosis or hernia (protrusion) is best removed with the help of a doctor rather than independently, therefore treatment of left-sided pain is the implementation of medical recommendations, and not the advice of relatives, neighbors or acquaintances. Self-medication often leads to sad consequences, especially when it comes to cardiac pathologies.

Most often, a painful symptom in the back, the shoulder blades is reflective, projection pain, the source of which is located in another zone. Therefore, after the removal of acute pain, all diagnostic measures should be carried out in full. Thus, the treatment of pain at the bottom of the left shoulder blade is the treatment of the underlying disease, which provokes a painful symptom. Therapeutic appointments for back pain, in the area of the shoulder blades, can be done by the following doctors:

• Traumatologist.
• Vertebrolog.
• Neuropathologist.
• Gastroenterologist.
• Cardiologist.
• Therapist.
• Psychotherapist, psychiatrist.

Treatment of pain in the left or right shoulder blade should begin with a visit to the local doctor, where the initial examination will be made and the course of further action will be chosen. Further, all stages of treatment will be assigned by a specialist after receiving the results of a comprehensive examination.

How to prevent pain under the left shoulder blade?

In order to prevent a pain symptom, it is necessary to find out its root cause, then the prevention of pain under the left shoulder blade will be really effective.

If a person suffers from angina pectoris, ischemic heart disease or has already suffered a myocardial infarction, the best prevention of pain under the left shoulder blade is a constant use of cardiovascular drugs, compliance with gentle physical activity, diet and psycho-emotional balance.

If the pain is caused by a deforming, progressive process in the spine, then pain prevention should consist of a long period during which special therapeutic exercises, non-steroidal anti-inflammatory drugs are performed

Pain at the bottom of the scapula, triggered by gastrointestinal diseases, is prevented by a sparing diet and taking antacids, prescribed drugs. In addition, YABZH very much depends on the psycho-emotional state, therefore, a positive attitude, mastering relaxation techniques, anti-stress techniques will help to prevent pain under the left shoulder blade.

Preventive measures in the prevention of pain symptoms and the development of the disease in principle - this is primarily regular medical check-ups. Even if there are no disturbing signs, pains, you should consult a doctor, undergo a preventive examination to make sure that neither pain nor illness will not threaten you in the near future.

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