Back pain between the shoulder blades

Back pain between the shoulder bladesoccurs with spinal pathology (postural disorders, osteochondrosis, ankylosing spondylitis), esophageal disease (gastroesophageal reflux disease, achalasia cardia, stricture), mediastinitis.Less commonly, symptoms develop on 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.Vessel condition is assessed using ultrasound and aortography.Pain is relieved by prescribing NSAIDs or narcotic analgesics.Treatment of the underlying disease is represented by drug, physiotherapeutic and surgical methods.

Causes of back pain between the shoulder blades

Respiratory disease

Pain between the shoulder blades occurs with acute tracheitis or bronchitis, when unpleasant sensations radiate from the chest to the back.During rest, the discomfort in the back is not noticeable, but it increases sharply when coughing, laughing, or when trying to speak loudly.Pain is dull;burning and rawness in the interscapular region is less common.Symptoms last 3-7 days, disappear without a trace after the inflammatory process subsides.

Postural disorders

Often the cause of pain between the shoulder blades is scoliosis, kyphosis or lordosis.Symptoms develop when sitting for a long time in an uncomfortable position, after sleeping on a mattress that is too soft or, on the contrary, very hard.A dull or aching pain appears, which worsens when bending over or making sharp turns.Unpleasant sensations are observed already at a young age, which is associated with the prevalence of postural disorders among children.

Similar signs are found in patients with a specific juvenile pathology - Scheuermann-Mau disease.In such cases, thoracic kyphosis increases, which is indicated by intense back pain and discomfort when being in one position for a long time.As the disease progresses, teenagers feel a sharp pain between the shoulder blades, which occurs in the evening.

Thoracic osteochondrosis

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

Severe interscapular pain is observed with a herniated thoracic spine.If the upper thoracic segment is affected, the clinical picture is complemented by numbness and tingling in the hands, and difficulty swallowing.The pathology of the mid-thoracic 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

The initial sign of this disease is discomfort mainly 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, increase in the morning, and decrease or disappear completely during the day.Pain decreases after a hot shower or bath or physical activity.

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

Esophageal disease

Most esophageal pathologies are characterized by pain radiating into the interscapular space.In this case, a clear connection is determined between discomfort and food intake, physical activity with the body bent forward.Symptoms are accompanied by a retrosternal burning sensation, heartburn, and sour belching.Often, back pain between the shoulder blades is caused by:

• GERD.For reflux esophagitis, a burning sensation behind the sternum and in the back area is typical 10-20 minutes after finishing a meal.Manifestations increase if the patient takes a lying position, bends a lot and does physical work.Frequent heartburn and sour belching are noted.
• Achalasia cardia.If there is a violation of the opening of the lower esophageal sphincter, sharp retrosternal and interscapular pain occurs when swallowing.At first, symptoms appear sporadically - when eating in a hurry, chewing food poorly and swallowing large pieces at once.Dysphagia then becomes permanent.
• Esophageal stenosis.The narrowing of the lumen of the organ is accompanied by difficulty 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 throughout the upper abdomen and moves to the interscapular area.Often, with a hiatal hernia, there is also pain in the precordial area, which is mistaken for an angina attack.Symptoms occur after eating, physical activity, and straining.To reduce discomfort, the patient induces vomiting or belching and drinks water.

Pathology of the aorta

Back pain occurs with aortitis.Uncomfortable sensations are localized between the shoulder blades, behind the sternum, sometimes they move to the neck or epigastric region.Less commonly, a painful burning sensation occurs in the chest and radiates to the back.Pain is a constant concern and does not depend on the action of external factors.Typically, tachycardia, shortness of breath during exercise, at rest, and dry cough are detected.

Unbearable retrosternal pain, radiating to the interscapular region and spreading from top to bottom, is observed by dissecting an aortic aneurysm.Sometimes the sensation is so strong that the patient loses consciousness due to a painful shock.Blood pressure drops, pulse becomes fast, oxygen starvation of the brain occurs.If a person is not given emergency medical treatment, there is a high risk of death.

Mediastinitis

Severe pain that starts suddenly and is felt in the area between the shoulder blades is a characteristic of acute posterior mediastinitis.Discomfort increases with swallowing, throwing the head back, and coughing.To reduce back pain and facilitate breathing, the patient sits with the head tilted forward, slightly bent.Edema and cyanosis of the upper body develop, and subcutaneous emphysema occurs occasionally.

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

Mediastinal cancer

Pain in the retrosternal area, which radiates to the area between the shoulder blades, is the main complaint of patients with malignant tumors of the mediastinum.These symptoms occur in the late stages of the disease and are caused by tumor growth into neighboring structures and nerve endings.Painful pain syndrome combined with shortness of breath and cough when the bronchus is involved in the process, dysphagia when the esophagus is affected, swelling and cyanosis of the face when the superior vena cava is compressed.

A rare cause

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

Diagnostics

The initial examination is carried out by an orthopedic traumatologist, who, after a physical examination, notices poor posture, curvature of the spine and other problems of the musculoskeletal system.If the pain between the shoulder blades is not associated with bone pathology, the patient is referred to a cardiologist, neurologist, or gastroenterologist.To find out the etiological factors of back pain, instrumental studies are prescribed:

• X-ray of the spine.Based on the x-ray results, the doctor determines the degree of scoliosis, the presence and severity of kyphosis or lordosis.This method is informative for diagnosing thoracic osteochondrosis and helps to describe bone changes after trauma.To detect intervertebral hernia, radiography is supplemented with CT or MRI of the spine.
• X-ray OGK.Standard research methods allow us to exclude lung disease as one of the causes of pain between the shoulder blades.X-ray imaging also shows widening of the mediastinal shadow and signs of subcutaneous emphysema, which gives the doctor the right to diagnose mediastinitis.
• EFGDS.To confirm the etiology of esophageal pain, endoscopic examination of the esophagus is performed.During the examination, the gastroenterologist pays attention to the patency of the organ, the coherence of the sphincter, and examines the condition of the mucous membrane of the organ.Biopsies are taken from suspicious areas for histological analysis.
• Ultrasound angioscanning.Ultrasound scanning of the aorta is used as a screening method to detect inflammatory changes and aneurysms.To assess the condition of the thoracic region, transesophageal echocardiography is performed.The diagnosis of dissecting an aneurysm is confirmed by the x-ray method - aortography.
• Laboratory methods.They play a supporting role in the diagnostic search.Patients undergo a standard complex: hemogram, biochemical blood tests, tests for hepatitis and HIV infection.According to the indications, a coagulogram is performed.In the case of a possible acute inflammatory process, data on acute phase indicators are informative.In patients with suspected ankylosing spondylitis, the HLA-B27 antigen is determined.

Given the various causes of interscapular pain, additional testing may be necessary.If there are disorders of the upper respiratory tract, a consultation with an otolaryngologist and a complete ENT examination is required.If a malignant tumor of the mediastinum is suspected, an oncologist is involved in the diagnosis.

Treatment

Help before diagnosis

Most non-medicinal measures are aimed at preventing pain between the shoulder blades: develop and maintain proper posture, eat a balanced diet without harmful foods, lead an active lifestyle and do sports.If the pain is severe during the diagnostic search, the doctor prescribes non-narcotic analgesics, recommends limiting mobility, and, if necessary, prescribes strict bed rest.

Conservative therapy

In the treatment of back pain between the shoulder blades, a different approach is used - the therapeutic regimen is selected individually, taking into account the main diseases that cause symptoms and concomitant 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 cause of pain:

• Nonsteroidal anti-inflammatory drugs.Prescribed to relieve discomfort in diseases of the osteoarticular system, as well as to eliminate inflammation and accelerate recovery.NSAIDs are also effective for respiratory diseases and mediastinitis.
• Antisecretory drugs.Proton pump inhibitors and H2-histamine blockers are the basis for the treatment of GERD and achalasia cardia.Medicines reduce damage to the esophagus from acidic stomach contents and relieve pain.To relieve the burning sensation quickly, non-absorbable antacids are taken.
• Antibiotics.Mass antimicrobial therapy is indicated for acute forms of mediastinitis to destroy pathogens and prevent bacterial complications.Medicines are chosen empirically.A combination of 2-3 agents is introduced to act on all possible types of microbes.
• Cytostatic.Polychemotherapy is chosen for some forms of mediastinal cancer in preparation for surgery or as palliative care.Immunosuppressants are sometimes recommended for patients with severe forms of ankylosing spondylitis.

Patients with acute conditions (aortic surgery, fulminant mediastinitis) are hospitalized in the intensive care unit.The goal of treatment is to eliminate the state of shock: for this purpose, cardiotropic drugs, infusion solutions are used, and oxygen support is provided.To relieve pain, narcotic analgesics and sedatives are given.

Non-drug methods play an important role in the treatment of musculoskeletal diseases.A special exercise therapy complex is prescribed to strengthen the muscle corset and form an even posture.Manual manipulation, kinesiotherapy, orthopedic massage of the chest, back, and lower back show good results.Several physiotherapeutic methods are used: electrical stimulation of the back muscles, peloid therapy, general ultraviolet radiation.

Surgical treatment

For persistent spinal deformities, surgical correction of scoliosis is recommended.Surgical treatment for osteochondrosis is used in cases of spinal compression: the intervertebral hernia is removed and the spinal canal is decompressed.As a rule, minimally invasive techniques are used: disc puncture vaporization, microdiscectomy.

Surgical intervention is indicated for complicated forms of diaphragmatic hernia and severe stenosis of the esophagus.The hernia hole is sutured with crurorrhaphy, gastropexy or fundoplication, resection and esophageal plasty.Emergency surgery is the only treatment for dissecting aneurysms.Vascular surgeons perform resection of the damaged area with reconstruction of the aorta.