Back pain and under the shoulder pain



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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For more information including a really instructive video, on Back Pain Upper Middle Shoulder Blades, go to:
Back Pain Upper Middle Shoulder Blades Special site with free instructive video and transcription on the topic of back pain upper middle shoulder blades.





This type of pain has many possible causes.

Referred pain- that is pain coming from sources elsewhere need to be considered. For instance, the pain associated with disorders of the esophagus, stomach (penetrating ulcer), and pancreas may cause pain under the right shoulder blade.

Any problem that causes irritation of the diaphragm can also cause shoulder pain. An example would be an ectopic pregnancy.

Pain from aortic dissection can also lead to referred pain to the upper spine and shoulder.

A viral respiratory infection could cause pleurisy (inflammation of the lining of the lung) that might cause pain in the back. Pneumonia and pulmonary emboli may also do this.

The most common internal referred pain leading to the right shoulder is gall bladder disease.

The term for this is “biliary colic.”

Biliary colic is an aching pain located in the upper abdomen, usually under the right rib cage. It is due to gallstones interfering with the normal flow of bile from the gallbladder. Bile is produced in the liver and stored in the gallbladder and is responsible for fat digestion. After a meal is eaten, bile passes from the gallbladder through the bile duct into the small intestine, where it mixes with food. If a gallstone blocks the passage of bile from the gall bladder to the intestine, the smooth muscle walls of the bile duct contract to try to move the stone. This is the cause of biliary colic.

A person with biliary colic complains of an ache in the upper abdomen. In some people, the abdominal pain spreads back toward the right shoulder blade. Many people also have nausea and vomiting.

Ultrasound is the diagnostic procedure of choice.

If the biliary colic is recurrent or persistent, surgery to remove the gallbladder (cholecystectomy) usually is recommended. This procedure can be done through small incisions using an instrument called a laparoscope.

A growth or tumor involving the ribs could cause shoulder pain and should be ruled out by an X-ray.

Disc herniation and arthritis in the neck can cause cervical radiculopathy (pinched nerve) and this can cause pain to be referred to the shoulder. In fact, any patient complaining of shoulder pain should have their neck examined as well.

Pain in the upper or mid back can come from trigger points in the muscles of the back.

Trigger points in the scalene muscles of the front and side of the neck can generate an irritating ache between the shoulder blades in the upper back.

Trigger points in the upper part of the rectus abdominus (stomach) muscle can be responsible for pain across the mid back.

Finally, primary shoulder disorders such as rotator cuff tendonitis, bursitis, and arthritis can cause pain that starts in the shoulder but also travels to the upper back. A special type of bursitis –subscapularis bursitis- is felt underneath the shoulder blade between the shoulder blade and the back. Patients complain of a rubbing feeling and on examination, a grating sensation can be noted.

Obviously, the appropriate treatment depends on making the correct diagnosis.





For more information including a really instructive video, on Back Pain Upper Middle Shoulder Blades, go to:
Back Pain Upper Middle Shoulder Blades Special site with free instructive video and transcription on the topic of back pain upper middle shoulder blades.




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