The scapula is a three-dimensional triangular bone that connects the humerus and the clavicle. He owes his name to the outward resemblance to a familiar tool - a garden shovel. The shoulder socket and the head of the humerus form the shoulder joint, which is the most flexible joint in the human skeleton.
Pain under the right shoulder from the back to 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 shoulder area 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 shoulder: subscapularis, coracohumeral, small and large rhomboid, deltoid. Most often it hurts under the right shoulder because a stretch has occurred or an inflammatory process develops.
Muscle stretching can cause severe back stress, weight lifting and holding, sudden movement, and uncomfortable prolonged posture. However, as practice shows, in more than half of the cases, the cause is excessive physical exercise by an unprepared person and improper exercise.
The symptoms of alignment are as follows:
- sharp pains of varying intensity;
- increased pain when turning and tilting the body;
- relief during rest;
- swelling and bruising (with severe damage).
The basic principle of treating spasms is complete rest and elimination of any stress. Immediately after the injury, you should apply ice or a cold compress to the injured area, if necessary, take an anesthetic pill.
With muscle inflammation - miosis - disturbing pain, which increases with pressure and movement. Sometimes there is slight swelling and redness. Often the general condition worsens: body temperature rises, the head aches and small painful seals are felt in the muscles.
The causes of myositis are various, but most often it develops against the background of acute respiratory viral infections, influenza or tonsillitis. It should be noted that in the chest region, muscles become inflamed relatively rarely, as myositis is localized mainly in the upper back or lower back.
One of the varieties is ossifying myositis 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 spots in the muscle structure that gradually enlarge and damage the surrounding tissues. The ossification (ossification) process can be localized almost anywhere - near the spine, in the limb or in the pelvic region.
Reference:ossifying myositis is incurable and does not even give itself surgical treatment. After the bones are removed, they form again.
Myofascial syndrome
Muscle pain in the back is more 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 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 strain.
A number of factors can provoke this process:
- skeletal abnormalities - 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, spondyloarthritis, as well as hernia and lengthening;
- long-term use of β-blockers, cardiac glycosides, calcium antagonists, antiarrhythmic drugs, anesthetics;
- connective tissue damage in autoimmune diseases - rheumatism, lupus erythematosus.
Cholelithiasis
With gallbladder pathologies, the pain often radiates to the right shoulder. This is due to a smooth muscle spasm when the bladder walls are irritated by the stones (stones) formed. An attack of biliary colic occurs, as a rule, suddenly, and is concentrated on the right side below the ribs.
Pain syndrome has an acute, cutting character and in most cases occurs after consuming fatty foods, fried, spicy, alcoholic beverages. The cause of an attack can be severe physical strain, nervous strain or prolonged sloping position.
If there is a blockage in the bile duct, the pain feels dull and attractive. An accompanying symptom is aggravation of 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 Odd sphincter, jaundice and staining of the stool develop.
Treatment of gallstone disease can be conservative and surgical. In the absence of complications, specific therapy is not performed. Single stones can be removed using shock wave lithotripsy.
Subphrenic abscesses
Back pain in the shoulder area 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 may be staphylococcus, streptococcus or E. coli.
The infection enters the body after partial or complete removal of the stomach, removal of the pancreas, suturing of the perforated ulcer, removal of the spleen. The cause can be an inflammatory pathology of the internal organs, open or closed trauma of the abdomen, as well as severe lesions of the lungs, osteomyelitis of the vertebral bones and ribs.
General symptoms appear first - weakness, sweating and fever. Increased body temperature can be maintained continuously or increased periodically. It then begins to injure the upper third of the abdomen and the lower chest on the affected side. Pain syndrome of varying intensity often radiates under the shoulder, shoulder blade, or clavicle.
A characteristic sign of an abscess is shortness of breath, dry cough, hives and increased pain when moving, taking deep breaths, coughing and sneezing. The patient breathes frequently and shallowly, trying to assume a semi-sitting position.
Treatment of subphrenic abscess consists of surgical opening and drainage of the abscess, followed by antibacterial, anti-intoxication, anti-inflammatory and restorative therapy.
Reference:if the operation is not performed in time, the abscess erupts in the abdominal and pleural cavities, which almost guarantees a fatal outcome.
Pleurisy
Pain near the shoulder can cause broncho-pulmonary disease - pneumonia or bronchitis, complicated by pleurisy. In this case, it can hurt both under the shoulder and above it. 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 breast 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 from other organs (mammary glands, ovaries). Metastatic pleurisy usually has mild symptoms and is often manifested only by pain behind the chest.
When a large amount of exudate accumulates, it is necessary to drill for its evacuation or drainage. Depending on why pleurisy has developed, specific treatment is prescribed. May include antibiotics, steroids, anti-inflammatory drugs. The form of tuberculosis is treated with special medicines.
Disease of urolithiasis
The formation of stones in the urinary system occurs most often in middle-aged people - from 25 to 50 years. The disease proceeds 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 chronic, prolonged 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 shoulder 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 agitation 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;
- development of renal failure;
- localization of stones in the kidney, renal or ureter;
- purulent pyelonephritis.
Surgery can be open or endoscopic. Shock wave lithotripsy is the mildest method to reduce the rate of postoperative complications.
During operation, the 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 stopped with medication.
Reference:any operation is not a guarantee of no returns. Therefore, complex therapy is necessarily performed, which can last for several years.
Intercostal neuralgia
Intercostal neuralgia (thoracalgia) is characterized by severe symptoms and is most often manifested by acute pain, piercing in the ribs, both in the front and in the back. It can appear intermittently or constantly disturbing. Pain syndrome is painful, burning or dull, but always difficult to bear.
A characteristic sign of neuralgia is a sharp increase in pain when you inhale, change body position or sneeze. Often, during a painful attack, the muscles tremble, sweating increases, the skin becomes red or, conversely, becomes pale. Numbness occurs at the site of nerve ending damage.
The immediate cause of the pathology is the capture of nerve roots, which is facilitated by various factors and diseases:
- osteochondrosis;
- spondylitis;
- ankylosing spondylitis;
- primary and metastatic tumors;
- stomach upset (gastritis);
- age-related changes in blood vessels;
- metabolic diseases;
- chest trauma;
- flu, SARS;
- hypothermia and sketches;
- prolonged or severe nervous stress;
- high physical activity;
- unsuccessful body twist, 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 aggravate 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 blockages with anesthetics and steroids are performed. To increase the excitability threshold of the CNS, sedatives are used.
Specific therapy depends on the origin of the neuralgia and may include antivirals, antihistamines, and muscle relaxants.
Neoplasia
Shoulder bone tumors are very rare and can be both benign and malignant. The first include osteoma and chondroma, the second - Ewing chondrosarcoma and 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 only appear when the surrounding structures - nerve roots and blood vessels - are compressed. The 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 shoulder, the tumor often degenerates into a malignancy. Due to the high risk of malice, such formations are radically removed.
Chondrosarcoma, like chondroma, is formed by cartilage tissue but is malignant and widespread. Its growth is accompanied by increased pain and swelling in the affected area.
Chondrosarcoma occurs in people of all ages, even children, but the highest percentage is in middle age - from 40 to 60. Mostly men suffer. The main method of treatment is tumor removal; if surgery is impossible, chemotherapy and radiotherapy are performed.
Ewing sarcoma is one of the most aggressive malignant tumors prone to early metastases. It affects children and young people, manifests itself in severe symptoms - pain, swelling and redness.
Since the tumor is very aggressive, surgical and therapeutic treatment is performed. Both before and after surgery, chemotherapy and radiotherapy are performed, and with the use of high doses and some medications. The prognosis of the disease is unfavorable condition.
Pain under the right shoulder can be a completely harmless symptom or indicate a serious illness. To get rid of the pain and prevent possible complications, you need a specialist consultation and examination. Based on his results, the doctor will prescribe treatment and give the necessary recommendations. Be healthy!