The scapula is a three-dimensional triangular bone that connects the humerus and collarbone. It owes its name to the external resemblance to the well-known tool - a garden shovel. The socket of the scapula and the head of the humerus form the shoulder joint, which is the most flexible joint in the human skeleton.
Pain under the right scapula from the back from the back in most cases indicates the pathology of the articular elements of the shoulder, spinal column or paravertebral (paravertebral) structures. Other possible causes are damage to internal organs - the bronchi, lungs, kidneys and gallbladder. Persistent pain syndrome in the area of the scapula almost always indicates a serious problem that requires medical and sometimes surgical treatment.
Muscle strain and inflammation
A large number of muscles are attached to the scapula: subscapularis, coracohumeral, small and large rhomboid, deltoid. Most often it hurts under the right shoulder blade because a stretching has occurred or an inflammatory process develops.
Muscle stretching can cause severe stress on the back, lifting and carrying weights, sudden movement and prolonged body uncomfortable position. However, as practice shows, in more than half of the cases, the cause is excessive physical exertion by an unprepared person and improper exercise.
The symptoms of a stretch are as follows:
- sharp pain of varying intensity;
- increased pain when turning and tilting the body;
- relief during rest;
- swelling and bruising (with severe damage).
The basic principle of the treatment of sprains is complete rest and the elimination of any stress. Immediately after the injury, you need to apply ice or a cold compress to the sore spot, if necessary, take an anesthetic pill.
With muscle inflammation - myositis - aching pain worries, which increases with pressure and movement. Sometimes there is slight swelling and redness. Often the general condition worsens: the body temperature rises, the head hurts, small painful seals are felt in the muscles.
The causes of myositis are diverse, but most often it develops against the background of acute respiratory viral infections, flu or tonsillitis. It should be noted that in the thoracic region, muscles become inflamed relatively rarely, since myositis is localized mainly in the upper back or in the lower back.
One of the varieties is myositis ossificans 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 ossified points in the muscle structure that gradually enlarge and injure the surrounding tissue. The process of ossification (ossification) can be localized almost anywhere - near the spine, on the limbs or in the pelvic area.
Reference:ossifying myositis is incurable and does not even lend itself to surgical treatment. After removal of ossificates, they are formed again.
Myofascial syndrome
Muscle pain in the back is the most common after headaches. More than 40% of people suffer from chronic pain syndrome, most of whom are 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 points are formed under the influence of trauma and muscle strain.
A number of factors can provoke this process:
- skeletal anomalies - scoliosis (curvature of the spine to the left or right), pelvic asymmetry, shortening of one of the limbs, flat feet;
- back injuries;
- spinal diseases - osteochondrosis, spondyloarthrosis, as well as hernia and protrusion;
- long-term use of drugs - β-blockers, cardiac glycosides, calcium antagonists, antiarrhythmic drugs, anesthetics;
- damage to connective tissue in autoimmune diseases - rheumatism, lupus erythematosus.
Cholelithiasis
With pathologies of the gallbladder, pain often radiates to the right shoulder blade. This is due to a spasm of smooth muscles when the walls of the bladder are irritated by the formed calculi (stones). An attack of biliary colic occurs, as a rule, suddenly, and is concentrated on the right side under the ribs.
The pain syndrome has an acute, cutting character and in most cases occurs after consuming fatty, fried, spicy foods, alcoholic beverages. The cause of the attack may be heavy physical exertion, nervous strain or prolonged incline position.
If there is a blockage in the bile duct, the pain is felt as dull and pulling. A concomitant symptom is heaviness in the abdomen on the right, as well as nausea, turning into vomiting. An increase in body temperature is possible, sometimes to high values. With blockage of the common bile duct and obstruction of the sphincter of Oddi, jaundice develops and feces become discolored.
Treatment of gallstone disease can be conservative and surgical. In the absence of complications, specific therapy is not carried out. Single stones can be removed using shock wave lithotripsy.
Subphrenic abscess
Soreness of the back 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. Most often, it appears after abdominal surgery, when peritonitis develops. The causative agent can be staphylococcus, streptococcus or E. coli.
The infection enters the body after partial or complete removal of the stomach, resection of the pancreas, suturing of the perforated ulcer, removal of the spleen. The cause may be an inflammatory pathology of internal organs, open or closed abdominal trauma, as well as severe lung lesions, osteomyelitis of the vertebral and rib bones.
General symptoms first appear - weakness, sweating and fever. The increased body temperature can be kept constantly or rise periodically. Then it begins to hurt in the upper third of the abdomen and lower chest from the affected side. Pain syndrome of varying intensity often radiates under the scapula, shoulder or collarbone.
A characteristic sign of an abscess is shortness of breath, dry cough, hiccups and increased pain when moving, taking a deep breath, coughing and sneezing. The patient breathes frequently and shallowly, tries to take a half-sitting position.
Treatment of subphrenic abscess consists in surgical opening and drainage of the abscess, after which antibacterial, anti-intoxication, anti-inflammatory and restorative therapy is performed.
Reference:if the operation is not carried out in time, the abscess breaks through into the abdominal and pleural cavities, which almost guarantees a lethal outcome.
Pleurisy
Pain near the scapula can cause broncho-pulmonary diseases - pneumonia or bronchitis, complicated by pleurisy. In this case, it can hurt both under and over 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. It can be caused by bacterial, viral or fungal infections, 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.
In 25% of patients with pleurisy, a malignant tumor is diagnosed - mesothelioma or metastases from other organs (breast, ovaries). Metastatic pleurisy usually has mild symptoms and is often manifested only by the aches behind the breastbone.
When a large amount of exudate accumulates, it is necessary to puncture for its evacuation or drainage. Depending on why pleurisy has developed, specific treatment is prescribed. It can include antibiotics, steroids, anti-inflammatory drugs. The tuberculosis form is treated with special drugs.
Urolithiasis disease
The formation of stones in the urinary system most often occurs in middle-aged people - from 25 to 50 years. The disease proceeds 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 of the stone, and the intensity depends on its size. Pain in the right scapula occurs when the right kidney is affected. If the stone is lower, then the lower back or lower abdomen hurts.
Typical symptoms of urolithiasis are frequent urge and burning sensation when urinating, fever, and nausea.
The method of treatment can be conservative and surgical. Most often, an operation is required, the indications for its implementation are:
- large stones;
- the development of renal failure;
- localization of calculus in the kidney, renal pelvis or ureter;
- purulent pyelonephritis.
Surgery can be open or endoscopic. Shock wave lithotripsy is the most gentle method to reduce the percentage of postoperative complications.
During the operation, stones are crushed by means of 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 relieved with medication.
Reference:any operation is not a guarantee of the absence of relapses. Therefore, complex therapy is necessarily carried out, which can last for several years.
Intercostal neuralgia
Intercostal neuralgia (thoracalgia) is characterized by severe symptoms and is most often manifested by acute, piercing pain in the ribs, both in the front and on the back. It can appear intermittently or constantly disturb. The pain syndrome is aching, burning or dull, but always difficult to bear.
A characteristic sign of neuralgia is a sharp increase in pain when inhaling, changing body position or sneezing. Often, during a painful attack, muscles twitch, sweating increases, the skin turns red or, conversely, turns pale. Numbness occurs at the site of damage to the nerve endings.
The immediate cause of the pathology is pinching of the nerve roots, which is facilitated by various factors and diseases:
- osteochondrosis;
- spondylitis;
- ankylosing spondylitis;
- primary and metastatic tumors;
- disruption of the stomach (gastritis);
- age-related changes in blood vessels;
- metabolic disease;
- chest trauma;
- flu, SARS;
- hypothermia and drafts;
- prolonged or severe nervous stress;
- high physical activity;
- unsuccessful turn of the body, prolonged stay in a static position.
Reference:intercostal neuralgia is characterized by pain that lasts from a few seconds to three minutes. During this time, the patient tries not to breathe or move, so as not to increase the pain.
The main direction of treatment is the relief of pain syndrome, for which anti-inflammatory nonsteroidal drugs (NSAIDs) are prescribed. In case of severe pain, therapeutic blockages with anesthetics and steroids are performed. To increase the threshold of CNS excitability, sedatives are used.
Specific therapy depends on the origin of the neuralgia and may include antiviral, antihistamines, and muscle relaxants.
Neoplasms
Bone tumors in the scapula are very rare and can be both benign and malignant. The former include osteoma and chondroma, the latter - chondrosarcoma and Ewing's 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 manifest itself only when the surrounding structures - nerve roots and blood vessels - are compressed. Treatment is only surgical, there are practically no relapses.
Chondroma is a benign tumor originating from cartilage tissue. It should be noted that when the chondroma is localized in the scapula, the tumor often degenerates into a malignant one. Due to the high risk of malignancy, such formations are removed radically.
Chondrosarcoma, like chondroma, is formed by cartilaginous tissue, but it is malignant and widespread. Its growth is accompanied by increasing pain and swelling in the affected area.
Chondrosarcoma occurs in people of any age, even in children, but the largest percentage is in the middle age - from 40 to 60. Mostly men suffer. The main method of treatment is removal of the tumor; if it is impossible to perform the operation, chemotherapy and radiotherapy are performed.
Ewing's sarcoma is one of the most aggressive malignant tumors prone to early metastasis. It affects children and young people, manifests itself in severe symptoms - pain, swelling and redness.
Since the tumor is highly aggressive, both surgical and therapeutic treatment is carried out. Both before and after the operation, chemotherapy and radiotherapy are performed, and with the use of high doses and several drugs. The prognosis of the disease is conditionally unfavorable.
Pain under the right shoulder blade can be a completely harmless symptom or indicate a serious illness. To get rid of pain and prevent possible complications, you need a specialist consultation and examination. Based on its results, the doctor will prescribe treatment and give the necessary recommendations. Be healthy!