Left upper back 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.

Click here: Second Opinion Arthritis Treatment Kit

Upper back pain occurring on the left side is a common condition.

The one area that needs to be checked first is the shoulder.

Because of the complexity of the shoulder joint, movements cause the shoulder to be vulnerable to sprains, strains, tears. Pain can occur involving the shoulder but may also cause upper back pain as well.

The shoulder joint is actually made up of three joints and one “articulation”, where the head of the humerus (the long bone of the upper arm), meets the the collarbone and the shoulder blade (scapula).

There are 4 main muscles that are involved in the complex movements of the shoulder. They comprise the rotator cuff. It is these muscles and tendons that are most vulnerable to tears, strains, sprains and inflammatory processes.

The medical evaluation will consist of various tests involving the movement of the arm through all range of motion (ROM), and neurological inspection to see if there is any nerve involvement. X-rays and MRI scans may be ordered.

Bursae are small sacks of fluid that allow muscles to glide smoothly as they are flexed or extended. Bursae can become inflamed. In an acute bursitis, the patient complains with any movement of the arm, and the pain is generally worse at night, with difficulty sleeping on the affected side. Pain and tenderness is generally located on the point of the shoulder. Acute bursitis, left untreated, can develop into a chronic bursitis.

Pains that occur along the top of the shoulder and upper back, and radiate into the side of the upper arm into the deltoid muscle, and further down the arm, , into the fingers, may be related to nerve impingement (pinched nerve) in the neck (cervical spine). The pain can be very intense on any movement of the arm.

Pains that occur over the shoulder blade (scapula) area can be due to the large muscle (trapezius) and underlying smaller muscles that have gone into spasm. The spasm of the muscles can be brought on by overuse or trauma. A “trigger point” can develop that sends out radiating pain.

Pains that occur under the shoulder blade be a warning that the pain is not in the shoulder itself, but can be due to a pain from one of the organs in the body. The shoulder where the pain occurs can give the clue to which of the organs are affected and causing the shoulder pain. Pain under the left shoulder blade can be a signal that there is a problem with the stomach or other abdominal structures (ulcers, pancreatitis, ectopic pregnancy) or in the chest (myocardial infarction [heart attack], pericarditis, pleuritis, pneumonia, pulmonary embolus, aortic dissection).

Pain in the spine area near the shoulder blade may also occur as a result of primary spine disorders such as degenerative disc disease and osteoporosis. Pain due to a pinched nerve in the neck or thoracic part of the spine will be felt in the upper back area. Pinched nerves arise as a result of disc disease, arthritis, or compression fractures.

Another possible cause is pleurisy. Sometimes pain from these sites will cause pain in the upper back. Sharp tearing pain in the upper back on the left side may signal aortic dissection, a potentially lethal problem.

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