The scapula is a three-dimensional triangular bone that connects the humerus and the collarbone. It owes its appearance to a well-known tool - the back of the garden. The head of the scapula and humerus form the shoulder joint, the most flexible joint in the human skeleton.
Back pain under the right scapula often indicates pathology of the articular elements of the shoulder, spine or paravertebral (paravertebral) structures. Other possible causes are damage to internal organs - bronchi, lungs, kidneys and gallbladder. Persistent pain syndrome in the scapular area almost always indicates a serious problem that requires medical and sometimes surgical treatment.
Muscle tension and inflammation
Many muscles are connected to the scapula: subscapularis, coracohumeral, small and large rhomboid, deltoid. It often hurts under the right shoulder blade because it stretches or develops an inflammatory process.
Muscle stretching can cause severe stress on the back, lifting and carrying weights, sudden movements, and prolonged body discomfort. However, in practice, in more than half of the cases, the cause is excessive physical exertion and improper exercise by an unprepared person.
Symptoms of stretching include:
- acute pain of varying intensity;
- increased pain when turning and bending the body;
- relaxation at rest;
- swelling and bruising (with severe damage).
The main principle of treatment of the nose is complete rest and elimination of any stress. Immediately after the injury, you should apply ice or cold compresses to the painful area, and if necessary, take an anesthetic pill.
With muscle inflammation - myositis - excruciating pain is a concern that increases with pressure and movement. Sometimes there is a slight swelling and redness. The general condition often worsens: body temperature rises, headaches and small painful seals are felt in the muscles.
The causes of myositis vary, but most often develop against the background of acute respiratory viral infections, influenza or tonsillitis. It should be noted that the muscles in the thoracic region are relatively rarely inflamed, because myositis is mainly localized in the upper or lower back.
One of the varieties is ossifying myositis or fibrodysplasia - an extremely rare form of the disease. This congenital disorder of osteogenesis (bone formation) develops rapidly and manifests itself in childhood.
Fibrodysplasia is the formation of bony spots in the muscle structure that gradually enlarge and damage the surrounding tissue. The ossification process (ossification) can be localized almost anywhere - near the spine, limbs or pelvic region.
Reference:ossifying myositis is incurable and does not lend itself to surgical treatment. Ossificates reappear after removal.
Myofascial syndrome
Muscle pain in the lower back is most common after a headache. More than 40% of people suffer from chronic pain syndrome in women.
Myofascial syndrome is a progressive condition characterized by the formation of trigger (pain) points in the muscles. The diameter of each point varies from 1 to 3 mm, the accumulation of points can create a painful area of 1 cm2. These spots are formed under the influence of trauma and muscle tension.
Many factors can trigger this process:
- skeletal abnormalities - scoliosis (bending of the spine to the left or right), pelvic asymmetry, shortening of one of the limbs, straight legs;
- back injuries;
- back diseases - osteochondrosis, spondyloarthritis, as well as hernias and bulges;
- long-term use of drugs-β-blockers, cardiac glycosides, calcium antagonists, antiarrhythmic drugs, anesthetics;
- connective tissue damage in autoimmune diseases - rheumatism, lupus erythematosus.
Cholelithiasis
In gallbladder pathologies, the pain often spreads to the right shoulder blade. This is due to the spasm of the smooth muscles when the walls of the bladder are irritated by the stones (stones) that form. The onset of biliary colic, as a rule, occurs suddenly and is concentrated on the right side under the ribs.
Pain syndrome is acute, cutting, and most often occurs after eating fatty, fried, spicy foods, alcohol. The cause of the attack may be heavy physical force, nervous tension or a stretching position.
If there is a blockage in the bile duct, the pain feels dull and painful. A concomitant symptom is heaviness in the right abdomen, nausea, and vomiting. An increase in body temperature, sometimes at high values, is possible. With obstruction of the common bile duct and obstruction of the sphincter of Oddi, jaundice develops and the stool becomes discolored.
Treatment of gallstones can be conservative and surgical. In the absence of complications, specific therapy is not performed. Single stones can be removed by shock wave lithotripsy.
Subphrenic abscess
Low back pain in the area of the shoulder blades can be explained by the formation of a subphrenic abscess - an abscess localized under the dome of the diaphragm. It often appears after abdominal surgery, when peritonitis develops. The causative agent may be staphylococcus, streptococcus or E. coli.
The infection enters the body after partial or complete removal of the stomach, resection of the pancreas, construction of a perforated ulcer, removal of the spleen. The cause may be inflammatory pathology of the internal organs, open or closed abdominal trauma, as well as severe lung lesions, osteomyelitis of the vertebral and rib bones.
At first, general symptoms appear - weakness, sweating and fever. Increased body temperature can be maintained constantly or rise periodically. Then pain begins in the upper third of the abdomen and lower chest on the affected side. Pain syndrome of varying intensity often spreads under the scapula, shoulder or sternum.
Characteristic symptoms of an abscess are shortness of breath, dry cough, hiccups, and increased pain when moving, deep breathing, coughing, and sneezing. The patient breathes frequently and shallowly, trying to hold a semi-sitting position.
Treatment of subphrenic abscess consists of surgical opening and drainage of the abscess, followed by antibacterial, anti-intoxication, anti-inflammatory and restorative therapy.
Reference:If the operation is not performed in time, the abscess spreads to the abdominal and pleural cavities, which guarantees a fatal outcome.
Pleurisy
Pain near the scapula can lead to broncho-pulmonary disease - pneumonia or bronchitis aggravated by pleurisy. In this case, it can damage both the bottom and the top of the scapula. However, the main source of pain is the chest and upper abdomen.
Pleurisy is always a complication of another disease, including malignant neoplasms. This can be caused by a bacterial, viral or fungal infection, trauma and chest surgery.
In some cases, pleurisy develops against the background of autoimmune diseases - scleroderma, rheumatoid arthritis, lupus erythematosus, vasculitis, as well as pulmonary thromboembolism, myocardial infarction, pancreatitis.
25% of patients with pleurisy are diagnosed with a malignant tumor - mesothelioma or metastases from other organs (mammary gland, ovaries). Metastatic pleurisy usually has mild symptoms and often manifests itself only with pain behind the bone.
When a large amount of exudate accumulates, it is necessary to dig a hole for its discharge or drainage. Depending on why the pleurisy develops, special treatment is prescribed. There may be antibiotics, steroids, anti-inflammatory drugs. The form of tuberculosis is treated with special drugs.
Urolithiasis
The formation of stones in the urinary system occurs most often in middle-aged people - between 25 and 50 years. The disease progresses in different ways: in some symptoms are limited to a single unpleasant episode, while others complain of regular exacerbations. In some cases, urolithiasis has a chronic, protracted course.
The main symptom is renal colic when the ureter is blocked. The localization of the pain syndrome depends on the location and intensity of the stone. Pain in the right scapula occurs when the right kidney is affected. If the stone is low, there is pain in the lower back or abdomen.
Typical symptoms of urolithiasis are frequent urination and burning sensation during urination, fever and nausea.
Treatment can be conservative and surgical. Often an operation is required, the indicators of its implementation are:
- large stones;
- development of renal failure;
- localization of stones in the kidney, renal pelvis or ureter;
- purulent pyelonephritis.
Surgery can be open or endoscopic. Shock wave lithotripsy is the most gentle way to reduce the percentage of postoperative complications.
During the operation, the stones are crushed by a reflector that emits electro-hydraulic waves. After crushing, stone particles and sand are excreted in the urine. Sometimes their movement along the ureter causes renal colic, which is easily stopped by this drug.
Reference:any operation does not guarantee the absence of relapse. Therefore, a complex therapy that can last several years is mandatory.
Intercostal neuralgia
Intercostal neuralgia (thoracic) is characterized by severe symptoms and is manifested by sharp, piercing pain in most ribs, both anterior and posterior. May cause intermittent or permanent discomfort. Pain syndrome is painful, burning, or dull, but it is always difficult to tolerate.
A characteristic symptom of neuralgia is a sharp increase in pain when breathing, changing body position, or sneezing. Often during a painful attack, the muscles twitch, sweating increases, the skin turns red or, conversely, becomes pale. Congestion occurs where nerve endings are damaged.
The immediate cause of pathology is compression of nerve roots facilitated by various factors and diseases:
- osteochondrosis;
- spondylitis;
- ankylosing spondylitis;
- primary and metastatic tumors;
- stomach upset (gastritis);
- age-related changes in blood vessels;
- metabolic disease;
- chest trauma;
- influenza, SARS;
- hypothermia and drafts;
- prolonged or severe nervous stress;
- high physical activity;
- unsuccessful rotation of the body, prolonged stay in a static position.
Reference:intercostal neuralgia is characterized by pain lasting from a few seconds to three minutes. During this time, the patient tries not to breathe or move to avoid increasing pain.
The mainstay of treatment is the elimination of pain syndrome, which is prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Therapeutic blockades with anesthetics and steroids are performed for severe pain. Sedatives are used to increase the excitability of the CNS.
Specific therapy depends on the origin of the neuralgia and may include antivirals, antihistamines, and muscle relaxants.
Neoplasms
Bone tumors in the scapula are very rare and can be both benign and malignant. The first includes osteoma and chondroma, the second - chondrosarcoma and Ewing sarcoma. Osteoma is characterized by slow growth and a favorable course. It mainly affects children and young people from 5 to 20 years old.
Osteoma can grow asymptomatically and can manifest itself only when the surrounding structures - nerve roots and blood vessels - are compressed. Treatment is performed only surgically, there is practically no relapse.
Chondroma is a benign tumor of cartilage tissue. When the chondroma is localized in the scapula, the tumor often turns into a malignant tumor. Such formations are eradicated due to the high risk of malignancy.
Chondrosarcoma, like chondroma, is caused by cartilage tissue, but is malignant and widespread. Its growth is accompanied by increased pain and swelling in the affected area.
Chondrosarcoma is found in people of all ages, even children, but the highest percentage is in middle age - between 40 and 60 years. Mostly men suffer. The main treatment is tumor removal, and if surgery is not possible, chemotherapy and radiotherapy are performed.
Ewing sarcoma is one of the most aggressive malignant tumors prone to early metastases. Affects children and young people, manifests itself in severe symptoms - pain, swelling and redness.
As the tumor is very aggressive, it is treated both surgically and medically. Chemotherapy and radiotherapy are performed both before and after surgery in high doses and with several drugs. The prognosis of the disease is conditionally unfavorable.
Pain under the right shoulder blade can be a completely harmless symptom or a sign of a serious illness. You need a specialist consultation and examination to get rid of the pain and prevent possible complications. Based on the results, the doctor will prescribe treatment and make the necessary recommendations. Bless you!