The scapula is a three-dimensional triangular bone that connects the humerus and the clavicle. It owes its name to the external resemblance to a well-known tool: a garden shovel. The cavity 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, spine or paravertebral (paravertebral) structures. Other possible causes are damage to internal organs: the bronchi, lungs, kidneys, and gallbladder. Persistent pain syndrome in the scapula area almost always indicates a serious problem that requires medical and sometimes surgical treatment.
Muscle tension and inflammation.
A large number of muscles are attached to the scapula: subscapular, coracohumeral, small and large rhomboids, deltoids. Most of the time it hurts under the right shoulder blade because a stretch has occurred or an inflammatory process develops.
Muscle stretching can cause severe stress on the back, lifting and carrying weights, jerky movements, and prolonged uncomfortable body position. However, as practice shows, in more than half of the cases, the cause is excessive physical exertion on the part of an unprepared person and improper exercise.
Symptoms of a stretch are as follows:
- acute pain of variable intensity;
- increased pain when turning and tilting the body;
- relief during rest;
- swelling and bruising (with severe damage).
The basic principle of treating sprains is complete rest and elimination of any stress. Immediately after the injury, you should apply ice or a cold compress to the sore spot, if necessary, take an anesthetic pill.
With muscle inflammation - myositis - painful pain, increasing with pressure and movement. Sometimes there is slight swelling and redness. Often the general condition worsens: the body temperature rises, the head hurts, and 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, the muscles are inflamed relatively rarely, since myositis is mainly localized in the upper back or 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 located almost anywhere: near the spine, on the extremities, or in the pelvic region.
Reference:Myositis ossificans is incurable and does not even lend itself to surgical treatment. After removing the ossified, they re-form.
Myofascial syndrome
Muscle pain in the back is the most common after headaches. More than 40% of people suffer from chronic pain syndrome, the majority of whom are women.
Myofascial syndrome is a progressive condition characterized by the formation of trigger points (pain) 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 strains.
Several factors can cause this process:
- skeletal abnormalities: scoliosis (curvature of the spine to the left or to the right), pelvic asymmetry, shortening of one of the limbs, flat feet;
- back injuries;
- diseases of the spine - osteochondrosis, spondyloarthrosis, as well as hernia and protrusion;
- long-term use of drugs: beta-blockers, cardiac glycosides, calcium channel blockers, antiarrhythmic drugs, anesthetics;
- damage to connective tissue in autoimmune diseases: rheumatism, lupus erythematosus.
Cholelithiasis
With pathologies of the gallbladder, the pain often radiates to the right shoulder blade. This is due to a spasm of the smooth muscles when the bladder walls are irritated by the formed stones (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 a sharp, cutting character and in most cases occurs after consuming fatty, fried, spicy foods, alcoholic beverages. The cause of an attack can be intense physical exertion, nervous tension, or a prolonged bending position.
If there is a blockage in the bile duct, the pain feels dull and pulling. A concomitant symptom is heaviness in the abdomen on the right, as well as nausea, which turns 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 the stool becomes discolored.
Treatment of gallstone disease can be conservative and surgical. In the absence of complications, no specific therapy is performed. Individual stones can be removed by shock wave lithotripsy.
Subphrenic abscess
Back pain in the area of the shoulder blades can be explained by the formation of a subphrenic abscess, an abscess located below 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, and removal of the spleen. The cause can be an inflammatory pathology of the internal organs, open or closed abdominal trauma, as well as severe lung injuries, osteomyelitis of the vertebrae and ribs.
The first general symptoms appear: weakness, sweating and fever. The increase in body temperature can be maintained constantly or increased periodically. Then it begins to hurt in the upper third of the abdomen and in the lower part of the chest on the affected side. Pain syndrome of varying intensity often radiates below the scapula, shoulder, or clavicle.
A characteristic sign of an abscess is shortness of breath, dry cough, hiccups, and increased pain when moving, taking deep breaths, coughing, and sneezing. The patient breathes frequently and shallowly, tries to adopt a semi-sitting position.
Treatment of subphrenic abscess consists of surgical opening and drainage of the abscess, after which antibacterial, anti-inflammatory, anti-inflammatory and restorative therapy is performed.
Reference:if the operation is not carried out in time, the abscess bursts into the abdominal and pleural cavities, which almost guarantees a lethal result.
Pleuritis
Pain near the scapula can cause bronchopulmonary diseases - pneumonia or bronchitis, complicated by pleurisy. In this case, it can hurt both below and above 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 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.
In 25% of patients with pleurisy, a malignant tumor is diagnosed - mesothelioma or metastasis of other organs (mammary gland, ovaries). Metastatic pleurisy generally has mild symptoms and is often manifested only by pain behind the breastbone.
When a large amount of exudate accumulates, it is necessary to perform a puncture for its evacuation or drainage. Depending on why the pleurisy developed, a specific treatment is prescribed. May include antibiotics, steroids, anti-inflammatories. The form of tuberculosis is treated with special drugs.
Urolithiasis disease
Stone formation in the urinary system occurs most often in middle-aged people, ages 25 to 50. The disease develops in different ways: in some, the symptoms are limited to a single unpleasant episode, while others complain of regular exacerbations. In some cases, urolithiasis has a long and chronic course.
The main symptom is renal colic when the ureter is blocked. The location of the pain syndrome depends on the location of the stone and the intensity depends on its size. Right scapula pain occurs when the right kidney is affected. If the stone is lower, then the lower back or abdomen hurts.
Typical symptoms of urolithiasis are frequent urgency 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 kidney failure;
- location of stones in the kidney, renal pelvis or ureter;
- purulent pyelonephritis.
Surgery can be open or endoscopic. Shock wave lithotripsy is the gentlest method to reduce the percentage of postoperative complications.
During operation, the stones are crushed by a reflector that emits electro-hydraulic waves. After crushing, the stone and sand particles are excreted in the urine. Sometimes its movement along the ureter causes renal colic, which is easily stopped 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 sharp, piercing pain in the ribs, both in the front and in the back. It can appear intermittently or constantly disturbing. The pain syndrome is aching, burning, or dull, but it is 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, the muscles contract, sweating increases, the skin turns red or, conversely, turns pale. Numbness occurs at the site of damage to 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 spondyloarthritis;
- primary and metastatic tumors;
- upset stomach (gastritis);
- age-related changes in blood vessels;
- Metabolic disease;
- chest trauma;
- flu, SARS;
- hypothermia and drafts;
- prolonged or severe nerve stress;
- high physical activity;
- Failed turning 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 non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed. For severe pain, therapeutic blocks with anesthetics and steroids are performed. To increase the CNS excitability threshold, sedatives are used.
Specific therapy depends on the origin of the neuralgia and may include antivirals, antihistamines, and muscle relaxants.
Neoplasms
Bone tumors on 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. The osteoma is characterized by slow growth and a favorable course. It mainly affects children and young people from 5 to 20 years old.
The 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 that originates in cartilage tissue. It should be noted that when the chondroma is located on the scapula, the tumor often degenerates into a malignant one. Due to the high risk of malignancy, such formations are radically removed.
Chondrosarcoma, like chondroma, is made up of cartilaginous tissue, but it is malignant and widespread. Its growth is accompanied by increased pain and swelling in the affected area.
Chondrosarcoma occurs in people of any age, including children, but the highest percentage is in middle age, 40 to 60. Most men have it. The main method of treatment is the removal of the tumor; if it is impossible to perform the operation, chemotherapy and radiation therapy are performed.
Ewing sarcoma is one of the most aggressive malignant tumors and prone to early metastasis. It affects children and young people, manifests itself in severe symptoms: pain, swelling and redness.
Since the tumor is very aggressive, both surgical and therapeutic treatment is performed. Chemotherapy and radiotherapy are performed both before and after the operation, and with the use of high doses and various 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 consultation and examination with a specialist. Based on your results, the doctor will prescribe the treatment and give the necessary recommendations. Be healthy!