Back pain upper middle shoulder blade

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 a number of causes.

Referred pain is pain coming from a source elsewhere. It is the cause that is most often missed because it is hard to diagnose. For instance, the pain associated with disorders of the esophagus, stomach (penetrating ulcer), and pancreas may cause pain under the right shoulder blade.

Anther example of referred pain is irritation of the diaphragm which can also cause shoulder blade pain. An example would be an ectopic pregnancy.

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

A viral respiratory infection can cause pleurisy (inflammation of the lining of the lung) that might cause pain in the back. In the same way, pneumonia and pulmonary emboli may do this.

The most common “internal” cause for pain leading to the right shoulder blade is gall bladder disease.

The term for this is “biliary colic.”

Biliary colic is a pain in the upper abdomen under the right rib cage. It is caused by blockage of the bile duct, the channel that connects the gall bladder to the intestine. When a gallstone blocks the flow of bile, the smooth muscle walls of the duct contract to try an force the stone out of the way. And this causes the pain of biliary colic.

In some people, the abdominal pain of biliary colic spreads back toward the right shoulder blade.

Diagnosis is made through history and physical exam and confirmed by ultrasound.

If the colic persists, surgery to remove the gallbladder (cholecystectomy) usually is recommended. This procedure can be done using an instrument called a laparoscope.

Tumors involving the ribs could cause discomfort and can 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 area between the shoulder blades.

Pain in the upper or mid back can come from trigger points in the muscles of the back. Multiple groups of muscles which can spasm include the erector spinae, multifidus, trapezius, infraspinatus, subscapularis, serratus posterior, rhomboids, and latissimus dorsi . This is particularly common in patients with fibromyalgia. Acute muscle strains also can cause pain between the shoulder blades.

Trigger points in the scalene muscles of the front of the neck can cause pain between the shoulder blades in the upper back. Again, fibromyalgia patients are often the ones who develop this problem.

Trigger points in the upper part of the rectus abdominis (stomach) muscle can radiate and cause pain across the mid back between the shoulder blades.

The shoulder joint consists of the acromioclavicular and glenohumeral articulations.

There are four main muscles and their associated tendons that play a major role in the integrity of the joint. Collectively, these comprise the rotator cuff. These muscles and tendons are vulnerable to tears, strains, sprains and inflammatory processes.

The shoulder is surrounded by small sacs of fluid called bursae. A bursa allows muscles to glide smoothly. Bursae can become swollen, inflamed or even infected. In an acute bursitis, the patient complains of pain with any movement of the arm. The pain can be worse at night.

Pain that radiates down between the shoulder blades could be shoulder related or could be referred from the neck. If the pain radiates further down the arm, then nerve impingement (pinched nerve) is the usual cause.

Pains that occurs over the shoulder blade (scapula) area can be due to trapezius muscle spasm. Spasms can be brought about through overuse or trauma. The muscle spasm can cause a “trigger point”between the shoulder blades to develop.

Here is a brief list of problems that can affect the shoulder and lead to shoulder blade pain or to pain occurring between the shoulder blades:

1. Rotator cuff tendinopathy.
2. Non-rotator cuff muscles such as the deltoid can be torn or strained.
3. Tendons and ligaments can be injured.
4. Inflammation of the shoulder joint due to arthritis.
5. Fractures due to osteoporosis.
6. Bursitis.
7. Cancer.

Pain in the spine next to the shoulder blade may occur as a result of primary spine disorders such as degenerative disc disease and osteoporosis-related fractures of the thoracic spine.

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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