Pain in the back between the shoulder blades

Pain in the back between the shoulder bladesoccurs in pathologies of the spine (postural disorders, osteochondrosis, ankylosing spondylitis), diseases of the esophagus (gastroesophageal reflux disease, achalasia of the cardia, strictures), mediastinitis.Less often, the symptom develops against the background of aortitis, aortic dissection or malignant tumors of the mediastinum.The diagnostic complex includes radiography of the spine, OGK, CT and MRI, endoscopy.The state of the vessels is assessed using ultrasound and aortography.Pain is relieved by prescribing NSAIDs or narcotic analgesics.The treatment of the main disease is represented by medication, 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 discomfort in the back is insignificant, but increases sharply when coughing, laughing or when trying to speak loudly.Pain is dull in nature;burning and swelling in the interscapular region are less common.Symptoms last 3-7 days, disappear without a trace after the inflammatory process subsides.

Postural disorders

Often the causes of pain between the shoulder blades are scoliosis, kyphosis or lordosis.Symptoms develop when sitting for a long time in an uncomfortable position, after sleeping on a too soft or, conversely, very hard mattress.A dull or aching pain appears, which is aggravated by bending over or making sharp turns.Unpleasant sensations are observed at an early age, which is related to the prevalence of postural disorders among children.

Similar signs are found in patients suffering from a specific juvenile pathology - Scheuermann-Mau disease.In such cases, thoracic kyphosis increases, which manifests itself with intense back pain and discomfort when staying in one position for a long time.As the disease progresses, adolescents feel a sharp pain between the shoulder blades that appears in the evening.

Thoracic osteochondrosis

Patients with degenerative spine disease suffer from dull pain in the back between the shoulder blades, which is due to constant muscle tension and compression of nerve structures.The discomfort becomes stronger when turning and bending the body, standing or sitting for long periods of time.With severe pain, a person's daily physical activity is limited.

Severe interscapular pain is observed with thoracic herniation.If the upper thoracic segments are affected, the clinical picture is complemented by numbness and tingling of the hands and difficulty swallowing.The pathology of the midthoracic region is characterized by intercostal neuralgia, and when the lower thoracic vertebrae are damaged, a sharp pain is felt in the epigastrium and under the ribs.

Ankylosing spondylitis

An early sign of the disease is discomfort primarily in the lumbar spine, but 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 decrease or disappear completely during the day.The pain subsides after a hot shower or bath or physical activity.

The spread of the pathological process in the thoracic spine is accompanied by increased kyphosis and tonic tension of the spinal muscles.Because of this, the pain in the interscapular area becomes constant and reduces the motor activity of the patient.Over time, a characteristic hump is formed on the back.A typical symptom of ankylosing spondylitis is sacroiliitis, an inflammation of the sacroiliac joint.

Diseases of the esophagus

Most pathologies of the esophagus are characterized by radiation of pain in the interscapular space.In this case, a clear connection between discomfort and food intake, physical activity with bending the body forward is determined.The symptoms are complemented by a retrosternal burning sensation, heartburn and sour belching.Back pain between the shoulder blades is most often caused by:

• COAT OF ARMS.Reflux esophagitis is characterized by a burning sensation behind the sternum and in the back 10-20 minutes after eating.Manifestations intensify if the patient assumes a lying position, bends a lot and performs physical work.Frequent heartburn and acid belching are observed.
• Achalasia of the cardia.If there is a violation of the opening of the lower esophageal sphincter, acute retrosternal and interscapular pain occurs at the moment of swallowing.At first, symptoms appear sporadically - with fast food, poor chewing of food and swallowing large pieces at once.Dysphagia then becomes permanent.
• Esophageal stenosis.The narrowing of the lumen of the organ is accompanied by difficulties in the passage of the food bolus, which causes sharp pain in the chest, the space between the shoulder blades.The patient feels that the food is stuck in the middle of the esophagus, and swallowing movements do not help to move it further and only increase the discomfort felt in the back.

Diaphragmatic hernia

It is characterized by severe pain that spreads to the upper abdomen and moves to the interscapular region.Often, with a hiatal hernia, there is also pain in the precordial region, which is mistaken for an attack of angina pectoris.Symptoms appear after eating, physical activity and exertion.To reduce discomfort, patients induce vomiting or belch and drink water.

Aortic pathologies

Back pain occurs with aortitis.Discomfort sensations are localized between the shoulder blades, behind the sternum, sometimes they move to the neck or epigastric region.Less often, there is a painful burning sensation in the chest that radiates to the back.Morbidity is a constant problem and does not depend on the action of external factors.Tachycardia, dyspnea on exertion, at rest and a dry intrusive cough are usually found.

With a dissecting aneurysm of the aorta, unbearable retrosternal pain is observed, radiating in the interscapular region and spreading from top to bottom.Sometimes the sensations are so strong that the patient loses consciousness from a painful shock.The blood pressure drops, the pulse accelerates, oxygen starvation of the brain occurs.If a person is not given emergency medical care, there is a high risk of death.

Mediastinitis

Intense pain that begins suddenly and is felt in the area between the shoulder blades is characteristic of acute posterior mediastinitis.Discomfort increases when swallowing, throwing back the head and coughing.To reduce back pain and facilitate breathing, the patient sits with the head tilted forward, slightly hunched over.Edema and cyanosis of the upper half of the body develop, sometimes subcutaneous emphysema appears.

Acute inflammation of the mediastinum is accompanied by massive intoxication, so the pain syndrome is accompanied by febrile fever, weakness and cardiac dysfunction.In chronic mediastinitis, the symptoms are less pronounced: moderate dull pain in the back, behind the sternum, prolonged subfebrile temperature and periodic swallowing disorders.

Mediastinal cancer

Pain in the retrosternal region, which spreads to the region between the shoulder blades, is the main complaint in patients with malignant tumors of the mediastinum.The symptom appears at a late stage of the disease and is caused by the growth of the tumor in neighboring structures and nerve endings.The excruciating pain syndrome is combined with shortness of breath and cough when the bronchi are involved in the process, dysphagia when the esophagus is affected, puffiness and cyanosis of the face when the superior vena cava is compressed.

Rare reasons

• Injuries: fracture of the spine, spondylolisthesis, crack or fracture of the scapula.
• Muscle diseases: myalgia, myositis, muscle-tonic syndrome.
• Lung diseases: pneumonia, dry or exudative pleurisy.

Diagnosis

The primary examination is carried out by an orthopedist-traumatologist, who after a physical examination finds bad posture, curvature of the spine and other problems of the musculoskeletal system.If the pain between the shoulder blades is not related to bone pathology, the patient consults a cardiologist, neurologist or gastroenterologist.In order to establish the etiological factors of back pain, instrumental studies are prescribed:

• X-ray of the spine.Based on the results of the X-ray examination, 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 hernia, radiography is supplemented by CT or MRI of the spine.
• X-ray picture of OGK.The standard examination method allows us to exclude lung diseases as one of the causes of pain between the shoulder blades.The X-ray image also shows an expansion 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 the 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 studies the condition of the mucous membrane of the organ.Biopsies are taken from suspicious areas for histological analysis.
• Ultrasound angioscan.Ultrasound scanning of the aorta is used as a screening method to detect inflammatory changes and aneurysms.Transesophageal echocardiography is performed to assess the condition of the chest area.The diagnosis of dissecting aneurysm is confirmed by X-ray method - aortography.
• Laboratory methods.They play an auxiliary role in the diagnostic search.Patients undergo a standard complex: hemogram, biochemical blood test, test for hepatitis and HIV infection.A coagulogram is performed as indicated.In the event of an acute inflammatory process, the data on the acute phase indicators are informative.In patients with suspected ankylosing spondylitis, the HLA-B27 antigen is determined.

Given the variety of causes of interscapular pain, further investigation may be warranted.In the presence of disorders of the upper respiratory tract, a consultation with an otolaryngologist and a complete ENT examination is necessary.If a malignant tumor of the mediastinum is suspected, oncologists are involved in the diagnosis.

Treatment

Help before diagnosis

Most non-medicinal measures are aimed at preventing pain between the shoulder blades: developing and maintaining proper posture, a balanced diet without harmful foods, leading an active lifestyle and playing sports.In case of severe pain during the diagnostic search, the doctor prescribes non-narcotic analgesics, recommends restriction of mobility and, if necessary, prescribes strict bed rest.

Conservative therapy

In the treatment of back pain between the shoulder blades, a differentiated approach is used - the therapeutic regimen is selected individually, taking into account the leading disease that caused the symptoms and accompanying pathologies.In the case of orthopedic problems, posture correction with the help of corsets and other orthoses comes to the fore.The following groups of drugs are used to treat the causes of pain:

• Nonsteroidal anti-inflammatory drugs.It is prescribed to relieve discomfort in diseases of the bone and joint system, as well as to eliminate inflammation and speed up recovery.NSAIDs are also effective in diseases of the respiratory organs and mediastinitis.
• Antisecretory drugs.Proton pump inhibitors and H2-histamine blockers are the mainstay of treatment for GERD and achalasia cardia.Medicines reduce damage to the esophagus from acidic stomach contents and relieve pain.Non-absorbable antacids are taken for quick relief of the burning sensation.
• antibiotics.In acute forms of mediastinitis, massive antimicrobial therapy is indicated to destroy pathogens and prevent bacterial complications.Medicines are chosen empirically.A combination of 2-3 preparations is introduced to act on all possible types of microbes.
• Cytostatics.Polychemotherapy is chosen for some forms of mediastinal cancer as preparation for surgery or as palliative treatment.Immunosuppressants are sometimes recommended in patients with severe forms of ankylosing spondylitis.

Patients with acute conditions (aortic dissection, fulminant mediastinitis) are hospitalized in an intensive care unit.The goal of treatment is to get rid of the state of shock: for this purpose, cardiotropic drugs, infusion solutions and oxygen support are provided.Narcotic analgesics and tranquilizers are used to relieve pain.

Non-drug methods play an important role in the treatment of diseases of the musculoskeletal system.To strengthen the muscle corset and form an even posture, special complexes for exercise therapy are prescribed.Good results are shown by manual manipulation, kinesitherapy, orthopedic massage of the chest, back and waist.A number of physiotherapeutic methods are used: electrostimulation of the back muscles, peloidotherapy, general ultraviolet irradiation.

Surgical treatment

In case of permanent deformities of the spine, surgical correction of the scoliosis is recommended.In case of compression of the spine, 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 disc, microdiscectomy.

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