Pain under the left shoulder blade

Pain under the left shoulder blade, while not 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 choose the right direction for diagnostic examinations and provide assistance, often emergency 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 reason - a disease of the spine, in addition, pain under the left shoulder blade can be a secondary sign of injury or pathological processes that develop in the internal organs and systems.

A general 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 injury of the suprascapular nerve).
  • Intercostal neuralgia.
  • Rib fracture.
  • Sprengel's disease (scapula alata) - winged scapula.
  • Myofascial syndrome.
• Diseases of the bronchopulmonary system:
  • Left-sided pneumonia.
  • Pleurisy (dry, left-sided).
  • Tracheobronchitis with autonomic dysfunction.
  • Acute bronchitis.
  • Left lung abscess.
• Cardiological diseases:
  • IHD – ischemic heart disease.
  • Myocardial infarction.
  • Pericarditis.
  • Angina pectoris (unstable, stable).
  • Mitral valve prolapse.
  • Less common - aortic aneurysm.
• Diseases of the gastrointestinal tract:
  • UG (Ulcus gastrica) – gastric ulcer.
  • Ulcus duodeni – ulcer of the duodenum.
  • Esophageal spasm.
  • GERD – gas esophageal reflux disease.
  • Rarely – exacerbation of pancreatitis.
• Psychogenic factor that provokes VSD – vegetative-vascular dystonia with reflected pain in the left side of the back.

Typical causes of pain under the left shoulder blade are ranked in order of prevalence:

• Cervical osteochondrosis, which most often manifests itself as one-sided pain at the bottom of the os occipitale - the occipital bone. The pain is aching in nature, intensifies with active head movements and constantly radiates under the shoulder blade, into the arm. Also, osteochondrosis of the cervical spine is accompanied by dizziness, numbness, paresthesia in the upper limbs.
• Intercostal neuralgia, which develops as a consequence of osteochondrosis or for other reasons. Neuralgia manifests itself as shooting, severe pain of a girdle nature with irradiation to the right or left, often under the shoulder blade.

Peptic ulcer (gastric 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:

• Hunger pain symptom that develops after a long period of time after eating (6-8 hours).
• An early pain symptom that develops immediately after eating can be reflected in the back, under the shoulder blade and subsides after the contents of the stomach are evacuated.
• A late pain symptom that occurs 2-3 hours after eating.
• A night symptom characterized by pain radiating under the shoulder blade.

Pain associated with peptic ulcer may subside after vomiting or taking medications.

Ulcer perforation (perforation), accompanied by sharp, shooting, cramping pains radiating to the collarbone, under the shoulder blade. A perforated ulcer is a condition that requires immediate medical attention; at the slightest suspicion of it, you should call for medical help, or try to get to a medical facility yourself.

Neurological pains associated with myofascial syndrome or vegetative-vascular dystonia. These symptoms are very similar to cardialgia, but do not manifest themselves in instrumental, hardware studies as deviations in the work of the heart. Similar conditions with pains of a pressing nature, radiating to the arm, to the back, are removed by sedatives, tranquilizers.

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

Aneurysma dissecans is a dissecting aneurysm of the aorta, which manifests itself as sharp pain in the chest area, radiating to the left side of the back, under the shoulder blade, and into the arm.

Symptoms of pain under the left shoulder blade

Signs and symptoms of pain in the lower scapula are caused by the following pathogenetic mechanisms:

1. Girdle pain localized on one side. This symptom is constant, less often paroxysmal, the pain may increase with deep breathing, shortness of breath, coughing, and movement. The symptom is caused by the spread of pain impulse along the intercostal muscle spaces, aponeurosis.
2. Burning pain with paresthesia caused by the transmission of impulses along the location of the nerve trunk, nerve branches. The pain is reflected in the heart area, in the back, in the lower back or under the shoulder blade.
3. Increasing pain radiating under the shoulder blade, into the arm, associated with hypertonicity of the muscles of the shoulder, shoulder blade, and back.

The pain symptom under the left shoulder blade can vary in sensation from aching, bearable to sharp, burning, cutting. There are certain typical complaints of pain under the left shoulder blade from patients:

• Acute pain on the left side of the back under the shoulder blade, the pain intensifies when turning, moving and subsides at rest.
• A cutting sensation on the left, moving into the area between the shoulder blades.
• Dull, aching pain below the left shoulder blade, felt when the arm(s) are raised up. The pain is associated with a certain body position.
• A nagging sensation of pain, the symptom extends below the left shoulder blade to the lower back. The pain is constant and is not relieved by cardiac medications.
• Sharp pain radiating to the left, subsiding after nausea and vomiting.
• Constant pain under the shoulder blade, which does not go away even at rest, the sensation of pain can increase and cause a burning sensation.
• The pain intensifies with deep breathing or coughing and goes away in a semi-recumbent position with the head raised.

Symptoms and manifestations of pain under the left shoulder blade can be grouped according to etiological features as follows:

Cardiological diseases: coronary heart disease, myocardial infarction, angina	The pain begins in the chest area (less often in the middle of the back) and is reflected to the left side - the arm, jaw, under the shoulder blade, back. The pain is of a spreading nature, causing a feeling of compression, burning
Aneurysma dissecans - aortic aneurysm	The pain symptom is characterized as constant, increasing, accompanied by sharp, shooting sensations to the left in the back, under the shoulder blade. The pain develops very quickly and is a life-threatening symptom.
Pericarditis - pericarditis	Pain reflected to the left side, subsiding at rest, in a sitting position, when bending forward
Pleuritis - pleurisy	A sharp, stabbing pain symptom, the intensity of which depends on the depth of breathing. The pain can be felt as a tingling sensation under the shoulder blade, and when taking a deep breath – as a cutting, strong, piercing pain.
Left-sided pneumonia	The pain is not intense, aching, transient, may increase with movement, deep breathing, the pain is reflected under the shoulder blade as a localized “point”
Cervical osteochondrosis	Aching, nagging pain that intensifies in statics or after physical exertion, the pain symptom can be reflected to the left, including under the shoulder blade. Unlike cardialgia, the pain is not relieved by cardiac drugs
Ulcerative processes in the gastrointestinal tract	The pain is intense, often unbearable. When perforated in the cardiac zone of the stomach, the pain is reflected to the left in the upper part of the back. The pain symptom at the initial stage of the process subsides after vomiting.

Pain on the left side under the shoulder blade

Pain on the left side of the lower shoulder blade may be associated with the following diseases:

• Ulcer process in the gastrointestinal tract. As a rule, the pain symptom increases - gradually in chronic diseases, rapidly in exacerbations or perforations. The pain is encircling, shooting, reflected and may subside after the food is evacuated into the intestines or through vomiting.
• Neurogenic pain, VSD (vegetative-vascular dystonia). The pain symptom is felt as squeezing, pressing, spreading to the left, often under the shoulder blade. VSD is also characterized by respiratory disorders, increased sweating, hand tremors, a feeling of spasm, a lump in the throat, a feeling of fear, panic.
• Pain on the left side under the shoulder blade may be associated with developing myocardial infarction, which is often felt as another attack of coronary heart disease, angina. The pain symptom, as a rule, begins to develop in the chest area, less often from the back, radiates to the left side, "spreading" and causing a burning sensation.
• Cervical osteochondrosis, less commonly thoracic osteochondrosis. 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 and the nature of the pain symptoms, which may be as follows:

The pain radiates under the left shoulder blade

The description of such a symptom is a typical characteristic of radiating pain, the pathological source of which can be located quite far from the site of pain. Pain radiates under the left shoulder blade most often in diseases of the stomach and heart. The cardiac zone of the stomach, undergoing an inflammatory or erosive process, often manifests itself as pain reflected to the left. It is not difficult for an experienced doctor to accurately determine the primary source of pain according to the diagnostic scheme of Zakharyin-Gedda 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 sensation under the shoulder blade

This is a signal of developing intercostal neuralgia, a protracted deforming process in the spine. However, the most typical sensation of burning pain is for an attack of angina pectoris and a more serious, life-threatening condition - myocardial infarction. A feeling of pressure, burning under the left shoulder blade, not relieved by cardiac drugs 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 (paleness) of the skin. In addition, burning under the shoulder blade, on the left side can be evidence of a psychogenic disease - vegetative-vascular dystonia, when in addition to the pain symptom, a person feels a strong feeling of fear, hand tremors, tachycardia, a lump in the throat appear.

Constant pain under the left shoulder blade

It may be a sign of developing left-sided pneumonia, dry pleurisy. Such pain is non-specific, however, if it intensifies 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 may 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 thoracic spine. Pain sensations are chronic, but can intensify paroxysmally, like bronchopulmonary symptoms, with coughing, active movements, deep breathing. Only a doctor can differentiate constant left-sided pain using an X-ray of the lungs and spine.

Pain under the left shoulder blade and cough indicate possible left-sided pneumonia, which also manifests itself with the following symptoms:

• Dry, less often wet cough. The most specific symptom, in addition to pain under the left shoulder blade, is the presence of pus or blood in the sputum. Even isolated discharge of this kind should be a reason for immediate examination and treatment.
• Subfebrile body temperature, which rarely increases. Hyperthermia is typical for the acute stage of pneumonia.
• Pain radiating towards the damaged lung. The pain symptom increases with deep inhalation, rapid breathing, exertion, coughing. Lung tissue is not equipped with pain receptors, they are located only in the pleura, therefore any painful pulmonary symptom can be considered a sign of pleurisy. Such symptoms should be differentiated from a possible deforming process in the cervical spine.
• Feeling short of breath, lack of air, shallow, rapid breathing.

Stabbing pain under the left shoulder blade

The so-called shooting pains, radiating to the right or left, are a typical sign of osteochondrosis, but a stabbing pain under the left shoulder blade may be a symptom of intercostal neuralgia, not associated with spinal deformity. Neuropathy is characterized by a feeling of tingling, tension, often burning, which subsides when changing body position, when relaxing or warming up the muscles. In addition, tingling in the back may indicate developing pneumonia or pleurisy, such a stabbing symptom appears when coughing, taking a deep breath or physical exertion that requires intense breathing (running, walking).

Pain under the left shoulder blade from behind is a pain symptom localized in the back. In clinical practice, such manifestations are called scapular-costal thoracalgia, or vertebrogenic pain. Pain under the left shoulder blade from behind can be differentiated from cardiac conditions in the following way:

Symptom	Ischemic heart disease (cardialgia)	Vertebrogenic pain
Description of pain	Pressing, squeezing, most often in the chest area, with reflection to the left. Accompanied by a feeling of fear	Stabbing, pressing, burning without anxiety, tachycardia
Periodicity of pain	Short-term, paroxysmal (several minutes, rarely up to half an hour)	Rarely - short-term, more often one that lasts several hours, possibly days
Changing body position	Does not affect the nature of pain	Affects, can increase or minimize pain symptoms
The impact of physical activity	It does affect, the pain may subside at rest	The pain may persist at rest and subside after physical exertion, as the static tension of the muscles changes.
Effect of drugs	The pain is relieved by cardiac medications	The pain is relieved by antispasmodics, analgesics. Nitrates (cardiological drugs) do not affect the nature of the pain.
The impact of manual therapy	Has virtually no effect	Significant relief due to the release of compressed nerve roots

Pain under the left shoulder blade from behind is not considered a concretizing, specific symptom, therefore, diagnosis of this symptom requires a comprehensive examination, possibly by several specialists.

Pressing pain under the left shoulder blade

This is a sign of developing osteochondrosis, a possible onset of an attack of coronary heart disease, and also evidence of an exacerbation of vegetative-vascular dystonia. A pressing pain under the left shoulder blade, which is felt as a bursting, burning pain, requires immediate medical attention and relief of the attack, since it is most likely associated with angina or a pre-infarction condition. A pressing pain under the left shoulder blade can also indicate a vegetative-vascular crisis, which is very similar in symptoms to cardiac pain, but is not relieved by cardiac drugs, but responds to sedatives or tranquilizers. Also, VSD is characterized by the absence of a cause-and-effect relationship between pain and physical activity, stress, while coronary heart disease can worsen with overexertion, intense work.

Throbbing pain under the left shoulder blade

This is most likely a manifestation of left-sided protrusion of the intervertebral disc of the cervical or thoracic spine. In addition to the fact that a herniated disc manifests itself as a pulsating pain under the left shoulder blade, it is accompanied by a headache, unstable blood pressure, dizziness, and paresthesia of the left arm. The left shoulder and the entire left half of the back to the waist may also hurt. Protrusions are detected using MRI and X-ray. Pulsation below the shoulder blade may be a symptom of incipient aortic dissection. Aortic aneurysm is a life-threatening condition; its rupture requires almost immediate medical attention, which is not always possible, so any reflected, pulsating pain in the back, 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 associated with compression, damage to the suprascapular nerve. Such an injury manifests itself as a sharp, sudden pain at the bottom of the shoulder blade, the pain symptom can spread to the shoulder and reduce the motor functions of the arm. Also, sudden pain under the left shoulder blade indicates radiculopathy, in which the nerve roots are pinched with left-sided displacement of the intervertebral discs of the cervical, less often thoracic spine. This is a secondary symptom, which is a consequence of chronic pressure on the nerve endings by osteophytes, herniated joint tissue. A long-term degenerative process is usually accompanied by aching constant pain, but a sudden exacerbation can be caused by protrusion of an intervertebral hernia or severe swelling in the area of displacement. Very rarely, sudden pain in the left shoulder blade can be a symptom of collapse of the left lung (pneumothorax). Such cases are not common in clinical practice, but sudden, sharp pain with shortness of breath and dizziness is a reason to call emergency care.

Sharp pain under the left shoulder blade

It may signal an attack of angina, which "starts" from the sternal area and manifests itself in spreading pain reflected to the left. Pain in angina is characterized as sharp, squeezing, squeezing, the symptom may subside at rest and after taking certain drugs - validol, nitroglycerin, other drugs that activate coronary blood supply. In addition, acute pain under the left shoulder blade can be caused by left-sided protrusion of the intervertebral disc, the symptom intensifies with movement, change in body position, that is, with a change in the position of the spine or ribs. The most dangerous is severe, acute pain in this area caused by perforation of the cardiac section of the stomach in peptic ulcer disease. This condition is accompanied by a drop in blood pressure, pulse (vagal pulse), sweating. The pain is so sharp that it is called "dagger-like", most often it begins in the epigastric zone and radiates to the left or right depending on where the perforation occurs. Also, for GU in the acute stage, a typical patient pose is characteristic - tucked legs, arms clasping the abdomen. Irradiation to the left side, under the shoulder blade is characteristic of atypical perforation, when the ulcerative process is localized in the posterior part of the wall of the duodenum or in the cardiac zone of the stomach.

Aching pain under the left shoulder blade

The aching nature of the pain indicates a chronic, protracted process that provokes the symptom. Most often, aching pain is associated with osteochondrosis of the cervical spine, as well as with chronic heart diseases - myocarditis, pericarditis. Aching pain under the left shoulder blade with inflammation of the heart muscle (myocarditis) is not constant, it can be provoked by overexertion, fatigue, stress and is accompanied by shortness of breath, pale skin, general poor condition, nausea. Pericarditis is characterized by increased pain and clear localization on the left, with irradiation to the arm, back, under the shoulder blade. The pain caused by the deforming spine can be varied - from aching, pressing, to shooting and then subsiding again. However, a tolerable, dull nature of the pain is one of the main signs of cervical osteochondrosis at 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 vague, weak pains radiating toward the pinched roots. The pulling, periodically subsiding sensations in the initial period do not bother a person very much, since they are quite tolerable, in addition, the pain can go away after warming up, massage, bathing in a warm bath. Often, a dull pain under the left shoulder blade gradually begins to become habitual, it is especially clearly felt after sleep, in the morning, or before bedtime after prolonged sedentary work or work requiring monotonous static tension. The pain spreads from the back of the head down the arm, along the back, under the shoulder blade, often accompanied by dizziness, nausea, paresthesia (numbness, tingling) in the hands.

Severe pain under the left shoulder blade

This is a reason to immediately consult a doctor, since an intense pain signal is not typical for the scapular zone, therefore, it is associated with a serious, possibly threatening condition. In the best case, severe pain under the left shoulder blade may signal intercostal neuralgia, but a more alarming cause may be a gastric ulcer or a pre-infarction condition, a heart attack. In a situation where the symptom is associated with a gastric ulcer, a person experiences such severe pain that he or she cannot move, pressing his or her arms or legs to the painful area. A piercing pain sign radiating to the left can serve as a direction in the diagnostic sense, since such a manifestation is typical of an ulcer in the cardiac zone of the stomach. Severe pain under the left shoulder blade may also indicate that an attack of angina is moving into the pre-infarction stage, especially when it is not relieved by cardiac drugs. In addition to a strong pain sensation, a person feels a spreading, burning sensation, possibly pressure reflected to the left side - to the arm, to the neck, under the shoulder blade.

Sharp pain under the left shoulder blade

It can 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 breathing is "caught". Irritation of nerve endings, roots can be of a permanent nature, but most often, episodic sharp pains are typical for neuralgia, the intensity of which subsides at rest or after warming up, relaxing the painful area. Also, sharp pain under the left shoulder blade is typical for left-sided pneumonia in the acute period, when the patient feels stabbing, cutting symptoms in the entire left half of the chest, reflected under the shoulder blade. Pneumonia in the acute stage is accompanied by a cough, which aggravates the pain, and pus or blood may also be released in the sputum. Much less often, pain is reflected in the left side of the back, in the shoulder blade area, during an exacerbation of pancreatitis, which is characterized by girdle, cramping pains.

Aching pain under the left shoulder blade

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

Diagnosis of pain under the left shoulder blade

Differentiation of symptoms in left-sided thoracalgia is extremely difficult, since the 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 exclude threatening conditions such as gastric ulcer, angina attack, pre-infarction and infarction, rupture of dissected aorta. To accurately determine the cause of the symptom, diagnosis of pain under the left shoulder blade should include the following actions:

• Interview and collection of anamnesis, including hereditary and professional. The patient is asked how the pain symptom is related to food intake, physical, static, emotional stress, where the pain radiates, how it is felt.
• Direct visual inspection, listening and palpation. It is also mandatory to measure the pulse, blood pressure, and possibly body temperature.
• X-ray examinations are prescribed, often in several projections, to clarify the nature of possible pathologies of the spinal column or bronchopulmonary system.
• An electrocardiogram is mandatory, which shows the parameters of the heart's functioning.
• CT and MRI may be prescribed. Computer tomography is a method that helps to specify a disease that is not determined by X-ray.
• If gastritis, gastroesophageal reflux, or gastric ulcer are suspected, fibrogastroduodenoscopy (FGDS) may be prescribed.
• A complete blood count (CBC) and urine analysis, possibly a serum chemistry panel, are standard diagnostic tests for almost any disease.

Treatment of pain under the left shoulder blade

Therapeutic prescriptions for left-sided thoracalgia, pain in the lower part of the shoulder blade directly depend on the diagnostic results. Primary treatment of pain under the left shoulder blade can only be associated with the relief of an acute condition that is life-threatening. If a person suffers from chronic coronary heart disease, then taking cardiac medications will help relieve the first painful sensations. If the pain does not subside within 5-10 minutes, an ambulance should be called. Acute pain caused by gastric ulcer, osteochondrosis or hernia (protrusion) is best relieved with the help of a doctor, and not independently, so the 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, the pain symptom in the back, shoulder blades is a reflective, projective pain, the source of which is in another area. Therefore, after the acute pain sensation has been removed, all diagnostic measures must 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 that provokes the pain symptom. Therapeutic prescriptions for back pain, in the shoulder blade area can be made by the following doctors:

• Traumatologist.
• Vertebrologist.
• Neurologist.
• 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 an initial examination will be performed and the direction of further actions will be chosen. Then all stages of treatment will be prescribed 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 painful symptom, it is necessary to find out its root cause, then prevention of pain under the left shoulder blade will be truly effective.

If a person suffers from angina, coronary heart disease, or has already had a myocardial infarction, the best prevention of pain under the left shoulder blade is the constant intake of cardiological drugs, 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 are performed and non-steroidal anti-inflammatory drugs are taken.

Pain at the bottom of the shoulder blade caused by gastrointestinal diseases is prevented by a gentle diet and taking antacids, prescribed medications. In addition, GU is very dependent on the psycho-emotional state, so a positive attitude, mastering relaxation techniques, anti-stress techniques will help prevent pain under the left shoulder blade.

Preventive measures to prevent pain symptoms and the development of the disease in principle are, first of all, regular medical check-ups. Even if there are no alarming signs or pain, it is worth consulting a doctor, undergoing a preventive examination to make sure that neither pain nor disease threatens you in the near future.

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