The scapula is a three-dimensional triangular bone that connects the humerus and clavicle. Its name is due to the external resemblance to a 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 in the posterior part of the back in most cases 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 area of the scapula 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 rhomboid, deltoid. Most of the time, it hurts under the right shoulder blade because it has stretched or an inflammatory process has developed.
Muscle stretching can cause severe back stress, lifting and carrying weights, sudden movements, and prolonged uncomfortable body position. However, as practice shows, in more than half of the cases, the cause is excessive physical effort by an unprepared person and the practice of inadequate exercises.
The symptoms of a stretch are as follows:
- acute pain of variable intensity;
- increased pain when turning and leaning the body;
- relief during rest;
- swelling and bruising (with severe damage).
The basic principle of treating sprains is complete rest and the elimination of any stress. Immediately after the injury, it is necessary to apply ice or a cold compress to the painful area, if necessary, take an anesthetic tablet.
In the case of muscle inflammation - myositis - intense pain, which increases with pressure and movement. Sometimes there is slight swelling and redness. Often, the general condition worsens: the body temperature rises, the head aches, and small painful marks are felt on the muscles.
The causes of myositis are diverse, but most often it develops in the context of acute respiratory viral infections, flu or tonsillitis. It should be noted that, in the thoracic region, muscles become inflamed relatively rarely, as myositis is mainly located in the upper 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 damage the surrounding tissue. The process of ossification (ossification) can be located almost anywhere - near the spine, in the limbs or in the pelvic region.
Reference:myositis ossificans is incurable and does not even lend itself to surgical treatment. After the ossificates are removed, they are formed again.
myofascial syndrome
Back muscle pain is the most common after headaches. More than 40% of people suffer from chronic pain syndrome, the majority being women.
Myofascial syndrome is a progressive condition characterized by the formation of trigger points (pain) in the muscles. The diameter of each stitch varies from 1 to 3 mm, the accumulation of stitches can create a painful area of 1 cm2. These points are formed under the influence of trauma and muscle tension.
Several factors can trigger this process:
- skeletal anomalies - scoliosis (spine bending to the left or right), pelvic asymmetry, shortening of one limb, flat feet;
- back injuries;
- spinal diseases - osteochondrosis, spondyloarthrosis, as well as hernia and protrusion;
- long-term drug use - β-blockers, cardiac glycosides, calcium antagonists, antiarrhythmic drugs, anesthetics;
- connective tissue damage in autoimmune diseases - rheumatism, lupus erythematosus.
cholelithiasis
With gallbladder pathologies, pain usually radiates to the right shoulder blade. This is due to smooth muscle spasm when the bladder walls are irritated by the formed stones (stones). An attack of biliary colic usually occurs suddenly and is concentrated on the right side under the ribs.
The pain syndrome has an acute and cutting character and, in most cases, it occurs after the consumption of fatty, fried, spicy foods and alcoholic beverages. The cause of an attack can be heavy physical exertion, nervous tension, or prolonged leaning.
If there is a blockage in the bile duct, the pain will be severe and painful. 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 at 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, specific therapy is not performed. Individual stones can be removed by shock wave lithotripsy.
subphrenic abscess
Back pain in the shoulder blade area can be explained by the formation of a subphrenic abscess - an abscess located under the dome of the diaphragm. Most of the time, it appears after abdominal surgery, when peritonitis occurs. The causative agent can be staphylococci, streptococci or E. coli.
Infection enters the body after partial or complete removal of the stomach, resection of the pancreas, suturing the perforated ulcer, removing the spleen. The cause can be an inflammatory pathology of internal organs, open or closed abdominal trauma, as well as severe lung injuries, osteomyelitis of the vertebral bones and ribs.
The first general symptoms appear - weakness, sweating and fever. The rise in body temperature can be sustained constantly or rise periodically. Then it starts to hurt in the upper third of the abdomen and in the lower chest on the affected side. Pain syndrome of variable intensity often radiates under the scapula, shoulder, or collarbone.
A hallmark sign of an abscess is shortness of breath, dry cough, hiccups, and increased pain when moving, breathing deeply, coughing, and sneezing. The patient breathes frequently and shallowly, tries to sit half-sitting.
The treatment of subphrenic abscess consists of surgical opening and drainage of the abscess, after which antibacterial, anti-toxic, anti-inflammatory and restorative therapy is performed.
Reference:if the operation is not performed in time, the abscess erupts into the abdominal and pleural cavities, which almost guarantees a lethal outcome.
Pleurisy
Pain near the scapula can cause bronchopulmonary disease - pneumonia or bronchitis, complicated by pleurisy. In this case, it can hurt both under 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 bacterial, viral or fungal infection, trauma and chest surgery.
In some cases, pleurisy develops in the context 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 (mammary gland, ovaries). Metastatic pleurisy usually has mild symptoms and is usually manifested only by pain behind the sternum.
When a large amount of exudate accumulates, it is necessary to puncture for evacuation or drainage. Depending on the reason for the development of pleurisy, a specific treatment is prescribed. May include antibiotics, steroids, anti-inflammatory drugs. The form of tuberculosis is treated with special medications.
Urolithiasis disease
The formation of stones in the urinary system occurs more often in middle-aged people - from 25 to 50 years. The disease develops in different ways: in some, symptoms are limited to a single unpleasant episode, while others complain of regular flare-ups. In some cases, urolithiasis has a chronic and prolonged 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. Pain in the right scapula occurs when the right kidney is affected. If the stone is lower, the lower back or abdomen hurts.
Typical symptoms of urolithiasis are frequent fissure and a burning sensation when urinating, fever and nausea.
The treatment method can be conservative and surgical. Most of the time, an operation is necessary, the indications for its implementation are:
- large stones;
- the development of kidney failure;
- location of the stone in the kidney, renal pelvis, or ureter;
- purulent pyelonephritis.
Surgery can be open or endoscopic. Shockwave lithotripsy is the mildest method to reduce the percentage of postoperative complications.
During operation, the stones are crushed by means of 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 does not guarantee the absence of relapses. Therefore, a complex therapy is needed, which can last for several years.
intercostal neuralgia
Intercostal neuralgia (thoracic pain) is characterized by severe symptoms and most often presents with sharp, stabbing pain in the ribs, both in the front and in the back. It may appear intermittently or constantly disturb. Pain syndrome is painful, burning, or dull, but always difficult to bear.
A characteristic sign of neuralgia is a marked increase in pain when breathing in, changing body position, or sneezing. Often, during a painful attack, the muscles contract, sweating increases, the skin becomes red or, conversely, pale. Numbness occurs at the site of damage to nerve endings.
The immediate cause of the pathology is the pinching of the nerve roots, which is facilitated by several factors and diseases:
- osteochondrosis;
- spondylitis;
- ankylosing spondylitis;
- primary and metastatic tumors;
- stomach upset (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 return 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, so as not to increase the pain.
The main direction of treatment is pain relief, for which nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed. For severe pain, therapeutic blocks with anesthetics and steroids are performed. To increase the threshold of excitability of the CNS, sedatives are used.
Specific therapy depends on the source of the neuralgia and may include antivirals, antihistamines, and muscle relaxants.
Neoplasms
Bone tumors on the scapula are very rare and can be 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 asymptomatic and manifest only when neighboring structures - nerve roots and blood vessels - are compressed. The treatment is only surgical, with practically no recurrences.
Chondroma is a benign tumor arising from cartilage tissue. It should be noted that when the chondroma is located in the scapula, the tumor often degenerates into malignancy. Due to the high risk of malignancy, such formations are radically removed.
Chondrosarcoma, like chondroma, is formed by 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, even children, but the highest percentage is in middle age - 40 to 60 years. Most men suffer. The main method of treatment is the removal of the tumor, if it is not possible to perform the operation, chemotherapy and radiotherapy are performed.
Ewing's sarcoma is one of the most aggressive malignant tumors with a tendency to early metastasis. It affects children and young people, manifests itself by severe symptoms - pain, swelling and redness.
As the tumor is highly aggressive, both surgical and therapeutic treatment are performed. Before and after the operation, chemotherapy and radiotherapy are performed, and with the use of high doses and various medications. The prognosis of the disease is conditionally unfavorable.
Pain under the right shoulder blade can be an entirely 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 your results, the doctor will prescribe the treatment and give the necessary recommendations. Be healthy!