Pain under the right scapula: nature, causes, diagnosis

Pain under the right scapula is a common complaint in clinical medicine. It can be absolutely harmless (stretching the muscle), and can indicate a pathology dangerous for life and health (sarcoma of the bone), so any pain under the right scapula deserves close attention and requires qualified medical care.

Right scapula: anatomical structure

The scapula is part of the trunk, bounded below by a horizontal line drawn through the lower edge of the scapula, with a vertical line that coincides with the projection of the medial scapula border; at the top - a line running between the appendage of the seventh cervical vertebra and the spinal-acromial joint, outside - the posterior border of the deltoid muscle and the middle axillary line. In the center of the scapular region is a scapula - a flat triangular bone adjacent to the posterior plane of the thorax between the seventh and second ribs. There are different shapes of the scapula: uniform, long, narrow, short, wide. In the blood supply of the scapular zone, the branches of the subclavian artery, connected with the branches of the axillary aorta, participate. The outflow of blood is carried out in the veins of the same name, the branches of the brachial plexus supply nerves to the scapular region.

Types of pain under the right scapula:

• local (somatic) pain. Always felt in the affected segment of the body or near it, is associated with a process that affects the pain nerves of bones, joints, ligaments, tendons, muscles. Mechanism: inflammation is a muscle spasm. Most often has a spilled character. It can be dull, aching, acute. "Leaves" when regenerating the damaged tissue / organ, adequately responds to therapy with analgesics;
• Reflected pain. It spreads within the boundaries of the dermatome (skin sections), which are interrelated with the innervation of problematic internal organs or vertebral structures. It is caused by diseases of the pancreas, digestive tract, kidneys, heart. Can be deep, aching, dull, combined with restriction of movements and paresthenia (sensitivity disorder);

• radiating pain. Occurs in the background of lesions of the nerve / root, is characterized by high intensity, distal migration from the area of ​​the corresponding dermatome. It is neurogenic in nature - it is associated with dysfunction of the nervous system. It is accompanied by vegetative / motor disorders, decreased blood flow, is immune to analgesics;
• dysfunctional pain. It is based on changes in the functional state of the central nervous system sites that control pain. Predisposing factors of occurrence: psychological, social, emotional.

The pain under the right scapula - what can it be?

Pain in the back under the right scapula is a nonspecific symptom of a dozen diseases. It is diffuse and local, cutting, compressive, pressing, acute and chronic. Can indicate diseases of the systems / organs within the scapular region (skin, muscle, rib, thoracic spine, intercostal nerves, right lung / pleura) and abnormalities in the internal organs (liver, intestine, right kidney, gallbladder).

1. Pain under the right scapula-pathology of the scapula of an oncological, infectious, traumatic nature:

   • developmental anomalies. Congenital aplasia (underdevelopment / absence) of the right scapula is extremely rare, usually fixed in conjunction with other genetic defects of the musculoskeletal system: pterygoid scapula and high standing scapula. The congenital pterygoid scapula must be differentiated with the acquired pterygoid scapula, resulting from injuries, myopathy, muscle paralysis;
   • damage / fracture of the right scapula. Dislocation of the right scapula proceeds with a lubricated symptomatology, under the influence or strong extension of the arm, the scapula turns, slipping to the outside, which provokes a rupture of the muscles that attach to the medial border of the right scapula and the spine. Movement in the joint of the shoulder is severely limited due to pain in the right side of the back. In 45-50% of cases, the injuries of the right scapula are accompanied by trauma to the nerves and vessels;

   • exostosis. It manifests itself as a characteristic crunch with movements of the right shoulder joint, a feeling of heaviness, moderate pains under the scapula;
   • osteomyelitis scapula. It develops after open injuries to the right shoulder blade (gunshot wound), accompanied by symptoms of intoxication, local manifestations (impaired function of the scapula, pain on the right behind). Migrating the purulent process to the anterior scapular part leads to deep muscular edema and increased pain;
   • tumors of the right scapula. Malignant (reticulosarcoma, chondrosarcoma) and benign (chondroma, osteoma, osteoblastoklastoma, osteochondroma) are malignant, causing permanent pain under the right scapula.

2. Pain under the right scapula - diseases of internal organs:

   • chronic pyelonephritis. In the second stage of the disease, the changes in the kidney tissue become sclerotic, provoking the appearance of periodic pulling pains that give off to the upper body or lower back. In the right-sided process, the pain migrates under the right scapula. Subjective manifestations: nausea, subfebrile temperature, painful urination. Acute pain can indicate the presence of a purulent infiltrate in the kidney;
   • chronic cholecystitis. It manifests itself by dull pain with localization in the zone of the right scapula from the back, giving off into the epigastrium. Attacks occur paroxysmally, without causing any special discomfort. It is combined with yellowing of the skin, vomiting, nausea, feverish condition;

   • dyskinesia of bile ducts. DZHVP hypotonic type is characterized by a slow development of pain in the right hypochondrium, which is reflected under the scapula and the right shoulder, is strengthened during tilt, deep inspiration. The main danger of undiagnosed pulling pain under the right scapula with dyskinesia is a high risk of developing cholelithiasis, acute cholecystitis, gastroduodenitis;
   • hepatic colic. Causes intense tearing pain, radiating to the right shoulder blade, right shoulder and neck. If the colic lasts 4-5 hours, painful sensations spread to the entire abdominal zone, accompanied by vomiting and nausea;

   • cholelithiasis. The failure of the gallbladder functioning is manifested by acute pains under the right scapula, reflected in the neck, jaw, shoulder, less often - into the heart area (cholecystocoronary syndrome);
   • pancreatitis. In the acute stage, the disease is combined with shingles that spread evenly under both scapulae. Inflammation of the head of the pancreas causes pain, concentrated under the right scapula and felt as a "chamber". In general, the pain is permanent, does not subside during a change in body position, does not gain intensity with coughing, inhaling, tensing;

   • cirrhosis of the liver. A typical clinical picture of cirrhosis (temperature jumps, jaundice, pruritus, ascites) on the "start" of cirrhosis is supplemented by pain under the right scapula and enlargement of the liver;
   • right-sided pneumonia. In 20-25% of cases it is asymptomatic at the first stage, showing itself only with periodic burning pain under the right scapula. What should alert: rapid breathing, excessive sweating at night, lack of response to antipyretic drugs, the temperature is above 38 degrees for three days;

   • subdiaphragmatic abscess. The reason for the formation of purulent contents in the cavity between the diaphragm and neighboring organs is infection of the body with bacterial agents. There is pain under the right scapula, greatly increasing when trying to take a deep breath, a slight increase in body temperature.

3. Diseases of the musculoskeletal system:

   • osteochondrosis of the cervical spine. It is a degenerative-dystrophic cascade, at various stages of which various factors have a priority in the formation of pain sensations: blockade / instability of vertebral segments, herniated intervertebral disc, stenosis of the spinal canal, arthrosis of the facet joints. All variants are characterized by a pulling pain with localization in the back, giving under the right scapula, in the buttock, waist. In most cases, osteochondrosis is accompanied by numbness of the fingers of the right hand and headaches;
   • scoliosis. Three-plane deformation of the spine (thoracic, cervical, lumbar), causing aching pain under the right scapula, in the back, shoulders, fatigue, malfunction in the intestines, stomach, lungs, heart muscle;

   • a syndrome of a humeroscapular periarthritis. Combines a variety of problems with the shoulder / shoulder region tendons, ligaments, muscles, resulting from unsuccessful movements, intense muscular work or systematic overload of the shoulder girdle, provoking pain giving under the right scapula;
   • bursitis. The inflammatory process of the scapula of the synovial membrane of the right shoulder joint causes dull pain under the right scapula;
   • tuberculosis of scapula;
   • shingles. Burning pain under the right scapula and intercostals provokes herpetic ganglionitis - inflammation of the near-vertebral nerve receptors. The acute stage of the disease is characterized by the absence of specific vesicles, which significantly complicates the diagnosis. The appearance of herpes rash in the intercostal spaces clarifies the picture and serves as an excuse for prescribing antiviral therapy.

   • myofascial pain syndrome. Source - trigger points, forming in the tendons, fasciae, muscles. A trigger point is a zone of hypersensitivity, pressure on which causes a sharp pain syndrome with a flinch ("jump symptom"), pain in a strictly defined place (reflected pain), remote from pressure. The most popular places of formation are the muscles of the head / neck, the right side of the back / shoulder, which causes the appearance of headaches, lumbago in the neck and under the right shoulder blade, radiating to the foot, thigh, buttock. Predisposing factors: microtrauma of muscles, long physical exertion, violation of posture, static overstrain.

4. Neurological disorders:

   • intercostal neuralgia. Infringement of the nerve roots with the displacement of the intervertebral discs to the right side develops against the background of constant compression of the nerve endings in the area of ​​their exit - in the "corridor", which is formed by various structures (articular tissue, hernia, osteophytes). As the degeneration of the intervertebral discs progresses, the lumen in the "corridor" narrows, the blood supply of the nerve endings worsens, edema and pain appear under the right scapula;
   • vegetative-vascular dystonia. In the development of psychomatous disorder, an inadequate response of the autonomic nervous system to the impact of stressful situations plays an important role, which leads to disruption in the functioning of many systems and organs of the body. The clinic VSD depends on the orientation of vegetative failures. Vagotonia is characterized by a feeling of "chilliness" and lack of air, dizziness, nausea, unmotivated aching pain in the back, irradiating under the right scapula.

Classification by nature of pain

Dull pain in right scapula from back

Indicates nephritis, pyelonephritis or chronic cholecystitis. Dull pain in the scapula is typical for malignant processes with localization in the internal organs located on the right side. Neoplasms of the right lung, right kidney, pancreas are manifested by right-sided dull pain irradiating under the scapula.

Sharp pain under the right scapula

A typical symptom of cholelithiasis, acute cholecystitis, hepatic colic. In 30-35% of cases, acute pain under the scapula "declares" itself dyskinesia of the gallbladder, arising from overeating, uncontrolled consumption of fatty / spicy dishes, emotional overload. In addition to pain, patients complain of sweating, insomnia, increased fatigue, general weakness, irritability.

Stitching pain under scapula on right side

Short-term pain, not associated with pathological diseases of internal systems / organs. In most cases, stitching pain indicates neurological disorders in the osteochondrosis of the thoracic / cervical spine, is provoked by physical exertion, a sharp turn of the trunk or uncomfortable posture. Sometimes transient pains are the first sign of exacerbation of cholecystitis, the onset of hepatic colic, or spasms of the walls of the bile ducts.

Sharp back pain under the right scapula

They "talk" about the last stage of the subdiaphragmatic abscess, the presence of purulent infiltrate in the kidney, renal colic. In this case, the pain rapidly increases during a deep inspiration, reflected in the shoulder and neck.

Drawing pains in the scapula to the right

Associated with spasms of the muscles of the shoulder girdle or structural deformations of the spinal column. Osteochondrosis of the cervical zone is characterized by drawing pain, gaining intensity with a constant static load, changing the position of the body. For all other diseases, pulling pains are atypical, excluding oncology of the right lung, kidney, liver, pancreas head.

Burning pain in the area of ​​the scapula to the right

Burning pain can indicate the infringement of nerve roots or dangerous conditions requiring immediate medical attention - right-sided pneumonia, atypical angina.

Constant pain in the scapula to the right

A characteristic manifestation of dyskinesia (malfunction of the motor) of the bile ducts is hypertensive. The pain develops gradually in the right hypochondrium, gives under the right scapula, in the right shoulder.

Aching under the right shoulder blade behind

Evidence of a chronic process that progresses in distant organs. Reflected aching pains are a clear sign of inflammation in the pancreas, gall bladder, kidneys, liver, which can not be ignored, as it can "hide" oncological diseases, which in the initial stages manifest themselves as irradiating aching pains.

Possible causes of periodic aching pain:

• tumor process in the right part of the LO;
• chronic pyelonephritis / cholecystitis;
• cholelithiasis, osteochondrosis;
• latent pneumonia / pleurisy in the right lung;
• hepatitis / cirrhosis;
• chronic bronchitis, pancreatitis.

Why there is a throbbing pain under the right scapula

Pulsating pain in the right segment is usually due to the protrusion of the disc, the progressive compression of the nerve endings. Protrusion is the first stage of the intervertebral hernia, which in time can lead to the formation of an intervertebral hernia, which "gives" more intense pain.

Anxiety symptoms requiring emergency care

Despite the many causes that cause pain in the right shoulder blade, there are potentially dangerous signs that pose a threat to life: spontaneous growing pain, provoking an "acute abdomen," hyperemia (up to 40 degrees), swelling of hands, vomiting "fountain", cyanosis of the skin , shortness of breath, sudden drop in pulse / blood pressure, fainting.

Diagnostic measures

With pain under the right scapula, a competent clinical examination makes it possible to separate patients with nonspecific and specific pain. "Symptoms of threat", allowing to suspect life-threatening diseases: a gradual increase in pain, stiffness of movements, paralysis, sensitivity disorders, oncology in the anamnesis, changes in blood / urine tests. Unexplained etiology of pain and its specific nature, which can indicate the presence of metabolic failures, infectious process, tumor / inflammatory spinal cord injury, somatic diseases of internal organs - an occasion for consultation with specialized specialists (gastroenterologist, neurologist, cardiologist, traumatologist).

Algorithm for differential diagnosis of pain under the right scapula:

• collection of anamnesis, objective definition of the nature of pain;
• measurement of pulse, blood pressure;
• palpation of the interscapular zone, back;
• carrying out orthopedic testing;
• identification of concomitant signs of pain;
• Exclusion of acute conditions that carry a threat to the life of the patient;
• confirmation / exclusion of the psychogenic origin of the pain;
• additional studies: ultrasound, MRI, cardiac CT, cardiogram, X-ray of the spine and thorax, FGD, bronchoscopy, urine / blood tests.

The pain under the right scapula should be treated only by a doctor who, depending on the diagnosis, chooses the optimal method of therapy for the underlying disease and pain in the scapular region. The therapeutic regimen can include surgical and surgical methods, massage, warming, reflexology and physiotherapy.