Back pain between the shoulder blades.

Back pain between the shoulder blades.occurs with pathologies of the spine (postural disorders, osteochondrosis, ankylosing spondylitis), diseases of the esophagus (gastroesophageal reflux disease, cardiac achalasia, stenosis), mediastinitis.Less commonly, the symptom develops against the background of aortitis, aortic dissection or malignant tumors of the mediastinum.The diagnostic complex includes x-ray of the spine, OGK, CT and MRI, endoscopy.The state of the vessels is assessed using ultrasound and aortography.The pain is relieved by prescribing NSAIDs or narcotic analgesics.Treatment of the underlying disease is represented by medications, 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, back discomfort is insignificant, but increases sharply when coughing, laughing, or trying to speak out loud.The pain is dull in nature;Burning and nakedness in the interscapular area are less common.The symptoms last 3 to 7 days and disappear without a trace once the inflammatory process subsides.

Posture 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 mattress that is too soft or, on the contrary, very hard.A dull or aching pain appears, which intensifies 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 suffering from a specific juvenile pathology - Scheuermann-Mau disease.In such cases, thoracic kyphosis intensifies, which is manifested by intense back pain and discomfort when staying in one position for a long time.As the disease progresses, adolescents feel sharp pain between the shoulder blades, which appears at night.

Thoracic osteochondrosis

Patients with degenerative spinal disease suffer from dull pain in the back between the shoulder blades, caused by constant muscle tension and compression of nerve structures.The discomfort intensifies when twisting 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 a hernia of the thoracic spine.If the upper thoracic segments are affected, the clinical picture is complemented by numbness and tingling in the hands and difficulty swallowing.Pathology of the mid-thoracic region is characterized by intercostal neuralgia, and when the lower thoracic vertebrae are damaged, 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, symptoms spread to the back between the shoulder blades.Unpleasant sensations develop in the afternoon or evening, intensify in the morning and during the day they decrease or disappear completely.The pain goes away after a hot shower or bath or physical activity.

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

Diseases of the esophagus

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 leaning forward.The symptoms are complemented by a retrosternal burning sensation, heartburn and sour belching.Most often, back pain between the shoulder blades is caused by:

• GERD.In reflux esophagitis, a burning sensation behind the breastbone and in the back area is typical 10 to 20 minutes after finishing a meal.The manifestations intensify if the patient lies down, bends a lot and does physical work.Frequent heartburn and sour belching are observed.
• Cardiac achalasia.If there is a violation of the opening of the lower esophageal sphincter, sharp retrosternal and interscapular pain occurs at the time of swallowing.At first, symptoms appear sporadically: when eating in a hurry, chewing food poorly, and swallowing large pieces at a time.Then the dysphagia becomes permanent.
• Esophageal stricture.The narrowing of the lumen of the organ is accompanied by difficulties in the passage of the bolus, which causes sharp pain in the chest, the space between the shoulder blades.The patient feels that the food is trapped 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 intense pain that spreads through the upper abdomen and moves towards the interscapular area.Often with hiatal hernia, there is also pain in the precordial region, which is confused with an angina attack.Symptoms occur after eating, physical activity, and exertion.To reduce discomfort, patients induce vomiting or belching and drink water.

Aortic pathologies

Back pain occurs with aortitis.Uncomfortable sensations are located 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 that 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 exertion, at rest, and dry, dry cough are detected.

In dissecting aortic aneurysm, unbearable retrosternal pain is observed, which radiates to the interscapular area and extends from top to bottom.Sometimes the sensations are so strong that the patient loses consciousness due to painful shock.Blood pressure drops, the pulse accelerates and a lack of oxygen occurs in the brain.If a person does not receive emergency medical care, there is a high risk of death.

mediastinitis

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

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

mediastinal cancer

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

rare causes

• Injuries: spinal fracture, spondylolisthesis, crack or fracture of the scapula.
• muscle diseases: myalgia, myositis, muscle tonic syndrome.
• lung diseases: pneumonia, dry or exudative pleurisy.

Diagnosis

The initial examination is performed by an orthopedic traumatologist, who, after a physical examination, notes 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 consulted by a cardiologist, neurologist or gastroenterologist.To find out the etiological factors of back pain, instrumental studies are prescribed:

• Spine x-ray.Based on the results of the x-ray, the doctor determines the degree of scoliosis, the presence and severity of kyphosis or lordosis.The method is informative in diagnosing thoracic osteochondrosis and helps to visualize post-traumatic bone changes.To detect an intervertebral hernia, the x-ray is complemented by a CT scan or MRI of the spine.
• X-ray of the OGK.The standard research method allows us to exclude lung diseases as one of the causes of pain between the shoulder blades.X-ray images also show a widening 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 pain, an endoscopic examination of the esophagus is performed.During the examination, the gastroenterologist pays attention to the permeability of the organ, the coherence of the sphincters and studies the state of the mucous membrane of the organ.Biopsies are taken from suspicious areas for histological analysis.
• Ultrasonic angioscanning.Ultrasound 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 aneurysm is confirmed by an X-ray method - aortography.
• Laboratory methods.They play a supporting role in the diagnostic search.Patients undergo a standard complex: blood count, biochemical blood test, test for hepatitis and HIV infection.According to indications, a coagulogram is performed.In case of a possible acute inflammatory process, data on the indicators of the acute phase are informative.In patients with suspected ankylosing spondylitis, the HLA-B27 antigen is determined.

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

Treatment

Help before diagnosis

Most non-pharmacological measures are aimed at preventing pain between the shoulder blades: developing and maintaining correct posture, eating 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 limiting 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 main disease that caused the symptoms and concomitant pathologies.In case of orthopedic problems, posture correction with the help of corsets and other orthoses comes to the fore.The following groups of medications are used to treat the causes of pain:

• Non-steroidal 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 diseases of the respiratory organs and mediastinitis.
• Antisecretory drugs.Proton pump inhibitors and histamine H2 blockers are the mainstay for the treatment of GERD and cardiac achalasia.The medications reduce damage to the esophagus caused by the acidic contents of the stomach and relieve pain.To quickly relieve the burning sensation, non-absorbable antacids are taken.
• antibiotics.Massive antimicrobial therapy is indicated for acute forms of mediastinitis to destroy pathogens and prevent bacterial complications.Medicines are selected empirically.A combination of 2-3 agents is introduced to act on all possible types of microbes.
• Cytostatics.Polychemotherapy is selected 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 illnesses (aortic dissection, fulminant mediastinitis) are hospitalized in the intensive care unit.The goal of treatment is to get rid of the state of shock: for this, cardiotropic drugs, infusion solutions are used, and oxygen is provided.Narcotic analgesics and tranquilizers are administered to relieve pain.

Non-pharmacological methods play an important role in the treatment of musculoskeletal diseases.Special exercise therapy complexes are prescribed to strengthen the muscle corset and form an even posture.Manual manipulation, kinesiotherapy and orthopedic massage of the chest, back and lumbar area show good results.Various 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 resorted to in the case of compression of the spine: the intervertebral hernia is removed and the spinal canal is decompressed.As a rule, minimally invasive techniques are used: vaporization by disc puncture, microdiscectomy.

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