Pain in the muscles of the scapula

Painful sensations in the muscles, myalgia, as a symptomatic phenomenon is not well understood, especially pain in the muscles of the scapula. Until now, the muscle pain symptom is referred to either vertebrogenic diseases or neurologic, that is, it is associated with radiculopathy, spondylarthrosis, osteochondrosis and so on.

Relatively recently in the classification of diseases, there appeared separate nosological units - 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 XIX century, there is no unity in the terminology and systematization of syndromes. Obviously, this is due to the close anatomical relationship of the soft (periarticular) tissues and bone structures in the back and in the human body in principle. Pathology of the back can cover several nearby anatomical zones, such pains are usually called dorsalgia, but painful manifestations in the region of scapularis (zone of scapula) are more correctly and more accurately called scapular.

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Causes of pain in the muscles of the scapula

Unlike other muscle syndromes, the causes of muscle pain in the scapula are most often not related to the "culprit" of all spinal pains - osteochondrosis. This is due to lack of mobility and a fairly strong structure of the thoracic spine. Consequently, almost all the painful sensations in the area of the scapula are associated with the muscle tissue, as well as with damage to the tendons, bony connectives.

The main cause of aching pain in the middle of the back is due to prolonged muscle tension, usually due to the specifics of professional activity. First of all, this applies to those who keep the same pose for a long time, sitting more often - drivers, office workers, seamstresses, students and so on. Accumulating, tension in the shoulders and in the zone of the scapula leads to compensatory shortening, contraction of the pectoral muscles, aggravates the state and habit of stooping, stretching the head, neck forward. As a consequence, the muscles that lift the shoulder blades, part of the trapezius muscle, the sternocleid, deltoid, are overtaxed, while others located in the middle of the back - the lower part of the trapezius, the flexors of the neck, the anterior dentate are subjected to compensatory stretching or weakening, all these abnormal, nonphysiological phenomena provoke pain.

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

1. Pectoral muscle (small pectoralis) or staircase syndrome. Pain in the zone of the scapula is manifested on the line of the 3-5th rib, felt like burning, bursting. The symptom may be worse at night, in the movement of the body, with the diversion of the hands (hyperabduction). Often, such manifestations resemble angina attacks, which greatly complicates the diagnosis. In addition, chronic hypertension of the small pectoral muscle leads to infringement of the nervous and vascular plexus, a bundle located near the beak-shaped scapular process, 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, is transmitted along the ulnar (ulnar) surface of the shoulder and forearm.
2. Syndrome m. Serratus posterior superior - the upper posterior cog muscle is often provoked by a degenerative process in the upper pectoral intervertebral discs. The pain is localized under the scapula, felt deep in the muscles, is aching, dull, painful.
3. Syndrome m. Serratus posterior inferior - the lower posterior muscular muscle is felt as a chronic, exhausting dull pain in the lower back (at the chest level). Syndrome restricts body movements when tilting, rotating.
4. Interblopping syndrome is felt as a lumpy, aching pain between the shoulder blades. The symptom increases with a prolonged horizontal position of the body, with tilts, the pain can become quite strong when traveling over rough terrain (vibration). The pain is localized at the point of attachment of the rhomboid, trapezius and latissimus muscles of the back (zone of the shoulder blade), it can spread to the shoulder, forearm along the ulnar nerve.
5. Syndrome of acquired pterygoid scapula, which provokes paralysis of anterior dentate, trapezius or rhomboid muscle. Paralysis can be caused by both an infectious disease, and trauma, bruising, including professional (athletes, circus performers).

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

1. Subcooling.
2. Infections, including viral infections.
3. Occupational diseases associated with hypertension of muscles.
4. Injuries to the back.

Quite often, the pain symptoms in the scapula area do not differentiate sensitively, so it is difficult to determine - what actually hurts - muscles, bone tissue, tendons or this symptom is a reflected pain indicating possible pathologies such as the following: 

• IHD is ischemic heart disease.
• Angina pectoris.
• Myocardial infarction.
• Protrusion or hernia of intervertebral discs of the thoracic spine.
• Kifoscoliosis.
• Intercostal neuralgia.
• Spondylarthrosis.
• YABZH - peptic ulcer of the stomach.
• Diseases of the respiratory system - pneumonia, pleurisy.

In order to correctly establish the causes of pain in the muscles of the scapula, it is necessary to describe the characteristics of the symptom as precisely as possible.

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How does the pain in the shoulder muscles manifest?

Symptomatology of muscle pains is characterized by sensations of tension, stretching. Unlike articular lomiashchih pain, the symptoms of pain in the muscles of the scapula often bear noel character. Although the interscapular muscles located between the spinous processes can ache quite intensively, like the joints. If the patient complains of a temporary pain in the area of the shoulder blades that radiates to the left, does not subside when the body changes, accompanied by a feeling of cold in the back, this is most likely a sign of the lesion of not only muscle tissue, but also tendons and ligaments.

The nature of pain in the area of the scapula can be different, depending on the source of the pain signal and the cause that provokes it: The parameters by which the symptoms of pain in the scapular muscles differentiate: 

• The description of the sensation is acute, aching, stitching, squeezing, breaking pain.
• Localization of pain - between the shoulder blades, under them, under the right or left, at the top of the scapula.
• The duration of pain is transient, prolonged, chronic.
• Dependence on the position of the body - subsides with the change of position, increases with certain movements.
• Distribution by species - visceral (reflected), neuropathic or only muscular pain.

How to distinguish the types of muscle pain in the scapula?

Symptom	Muscular	Reflex, visceral	Neuropathic
Description	Accurate characteristics, including indication of localization	The description is vague, the pain diffuse, comes from within, from the depth to the muscles	The pain spreads in the direction of the nerve roots, irradiates
Are there any restrictions on movements?	Often restricts motor activity	The movements are unlimited	The movements of the limbs are little limited, the restrictions concern the volume of movements of the chest, the back
Effect of movement on pain	Pain is aggravated by movement	Does not render	Has only axial load, as well as reflex movements - coughing, sneezing
Definition with palpation	Palpable areas are well palpated. Palpation aggravates the pain	The source of the symptom with palpation can not be detected	Possible definition

Pain in the muscles under the scapula

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

• Stomach ulcer, which is most often localized in the epigastric zone, but can irradiate to the left side - in the chest area, under the left scapula. The pain is not differentiated in the structural form, it is difficult to determine what exactly it hurts - muscles, ribs. Therefore, if the pain under the scapula is associated with food intake, most likely it is due to a disease of the gastrointestinal tract.
• A stroke of angina often resembles the signs of pain in the muscles under the scapula. It is difficult to differentiate these two symptoms independently, however, with angina pectoris, the pain subsides after taking vasodilator drugs, muscle pain can not be neutralized by these drugs.
• Intercostal neuralgia can also manifest as paroxysmal, shingles in the lower part of the scapula. Pain is worse when coughing, sneezing, painful areas are well defined by palpation.
• Muscular spasticity of the gallbladder, blockage of the bile ducts is often manifested in the form of colic, with the pain can be sharp, cutting, irradiate in the upper right part of the body, under the shoulder and right shoulder blade.

In any case, a simple pain symptom, which a person considers to be muscular, must pass without specific treatment for a maximum of 1-2 days. For relaxation of the muscles, there is enough rest and relaxation, if the pain under the shoulder blades does not subside, it is necessary to urgently seek medical help.

Diagnosis of pain in shoulder muscles

The task of diagnostic measures in determining the cause of muscle pain in the scapula is primarily the elimination of possible life-threatening pathologies - angina pectoris, myocardial infarction, perforation of the stomach ulcer and such diseases: 

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

This is due to the fact that the diagnosis of pain in the muscles of the scapula is difficult due to the nonspecific symptomatology, the clinical picture rarely indicates a specific diagnostic direction, in addition, almost all dorsalgia 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 any reliable pathological source of pain, it also happens that the studies determine a pathology that is not accompanied by a clearly expressed clinical sign.

As a rule, the diagnosis of pain in the muscles of the scapula includes such actions: 

• A brief history, a detailed description of prehistory symptom is not required, since the muscular pain symptom is not considered pathogenic for dangerous, threatening pathology.
• Specification of the nature and parameters of pain: 
  • Localization, possible irradiation.
  • At what position, the position of the body appears pain.
  • What time of day does the pain disturb?
  • Relationship symptom with motor activity, other factors.
  • The rate of symptom development is spontaneous or increasing pain.
• Visual inspection of the patient:
  • Asymmetry of the humerus zone.
  • Identification of possible scoliosis, anomalies of the structure of the spine (test-symptom Forestier).
  • Mobility of the vertebral column in the thoracic region (Ott test-symptom, Thomayer's symptom).
  • Determination of possible morbidity along the course of spinous processes (Zatsepin's symptom, Vershchakovsky's test, bell symptom).
• Instrumental examination is often not required, since 95% of muscle pain is considered benign. Studies are needed only in cases of suspicion of such pathologies: 
  • Signs of an acute infectious process.
  • Signs of oncology.
  • Explicit neurological symptoms.
  • Injury.
  • Ineffective treatment for a month.
  • Also, radiography is necessary if the patient is directed to manual therapy or physiotherapy procedures.
• Electromyography can be used to identify the characteristics of the muscular structure.

It should be noted that the widely used practice of sending a patient with muscular pain to the X-ray can significantly complicate the diagnosis, since in the overwhelming majority of our contemporaries have some signs of osteochondrosis and other diseases of the spine. In itself, the presence of a degenerative process in the spine does not exclude the myogenic factor that provokes pain in the muscles of the scapula and can not be the basis for proper diagnosis.

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Treatment of pain in the muscles of the scapula

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

Urgent measures	Long-term activities
Neutralization of the pain symptom with analgesics or anti-inflammatory non-steroid drugs	Prevention of causes that cause muscle pain
Purpose of myeloraxants	Gentle tensile or dynamic exercises
Injection or acupuncture impact on TT (trigger points)	Exercises aimed at correcting the posture
Kupirovanie, neutralization of comorbid symptom-complexes	Correction of the professional load
	Normalization and maintenance of weight
	Psychocorrection of pain symptoms
	Compliance with the rules of a healthy lifestyle, including motor activity

In general, the treatment of muscle pain is not difficult, as a rule, it is enough to give rest to over-strained muscles, to exclude symptom provoking factors. Also, a good result is massage and training in relaxation techniques, including post-isometric relaxation.

How to prevent muscle pain in scapula?

How to prevent muscular pain, wherever it develops, in the back, in the field of scapula, waist, neck? Obviously, there are no specific recommendations, because every human body is unique in its anatomical structure, physiological and other parameters. Nevertheless, the prevention of pain in the muscles of the scapula is the observance of well-known, but, unfortunately, rarely used in practice measures. These rules relate primarily to such items: 

1. If a person undergoes treatment for a muscle or other pain, a disease, it is necessary to strictly observe and fulfill all medical appointments. 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 passing the course of treatment of muscular pain, it is necessary to observe a gentle motor regime, however this does not mean complete peace and inaction. The muscles need to be trained, otherwise there will be an opposite hypertonic effect - adynamia, atrophy and weakness of the muscular structure.
3. Muscular tone is good for regular exercise, even if a person is not engaged in professional sports, simple morning exercises can easily replace complex training.
4. It is necessary to exclude all the factors provoking static stress. If a person's professional activity is associated with constant overstrain of the muscles of the shoulder blades, during the work day it is necessary to regularly change the position of the body. Perform workouts.
5. To maintain muscle tone, unload the spine, you need to monitor your posture, if necessary, wear a corrective corset.

Pain in the muscles of the scapula is a rather complex polyethological symptom, and not an independent disease. Determine the exact cause of pain, carry out all necessary for this examination and appoint an effective treatment can only a doctor. From the person who is experiencing discomfort in the zone of the shoulder blades, it is only necessary to take care of one's health and promptly seek help at the first alarming signs.