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General Practice 2023

Pain in the escápula: 9 main causes and what to do

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Pain in the escápula: 9 main causes and what to do
Pain in the escápula: 9 main causes and what to do

The scapula, also known as the shoulder blade, is a flat, triangular bone, located in the upper back, which has the function of stabilizing and assisting the movement of the shoulders. The scapula joint with the shoulder allows the mobilization of the arms and is composed of a set of muscles and tendons, called the rotator cuff.

There are alterations and certain diseases that can arise in the scapula region and cause pain, such as muscle damage, fibromyalgia, winged scapula and bursitis. The causes of these changes and diseases are not always known, but they may be related to incorrect posture, excess strength and weight in the arms, as well as trauma and fracture.

Some changes and diseases that can cause pain in the scapula are:

1. Muscle injury

The scapula assists in moving the shoulder through muscles located in the back, such as the rhomboid muscle. This muscle is located between the last vertebrae of the spine and the edges of the scapulae, so excessive physical exertion or sudden movements with the arms can lead to a strain or stretch of the muscle, causing pain in the scapular region.

In some cases, an injury to the rhomboid muscle can also cause reduced strength in the arms and pain when moving the shoulder, and these symptoms usually disappear over time as the body recovers.

What to do: in mild injuries, resting and applying a cold compress to the site is enough to relieve the pain, but if the pain continues after 48 hours, it can be if you apply warm compress and anti-inflammatory ointment.However, if symptoms worsen or last for more than 7 days, it is recommended to consult an orthopedist who may recommend the use of anti-inflammatory drugs and analgesics to reduce inflammation and relieve pain.

2. Bursitis

In the region of the scapula there are pockets of fluid that serve to cushion the impact of arm movements, called bursas. When the bursae are inflamed, they cause a disease called bursitis and cause intense pain, especially on colder days and when moving the arm. This inflammation can also affect the shoulder region and cause scapula pain. See more about what is shoulder bursitis and the main symptoms.

What to do: to relieve pain in the scapula caused by bursitis, ice can be applied to the site for 20 minutes, 2 to 3 times a day. The orthopedic doctor may also recommend pain relievers, anti-inflammatory drugs, and corticosteroids to improve pain and decrease inflammation.

Furthermore, it is important not to strain the arm, on the side where the pain is intense, and it is necessary to perform physiotherapy exercises to strengthen the muscles of the region and help to reduce the inflammation of the area.

3. Winged scapula

The winged scapula, also known as scapula dyskinesia, occurs when the positioning and movement of the scapula occurs incorrectly, giving the sensation of being out of place, causing pain and discomfort in the shoulder region. Winged scapula can occur on either side of the body, however, it is more common on the right side and can be caused by arthrosis, unconsolidated clavicle fracture, paralysis and changes in the thorax nerves and kyphosis.

The diagnosis is made by an orthopedic doctor through physical examination, and electromyography may be requested to analyze the functioning of the muscles in the scapula region. Find out more about how the electromyography test is performed and what it is for.

What to do: after confirming the diagnosis, the orthopedist may prescribe medication to relieve pain, however, in most cases, surgery is recommended to repair the nerves in the back of the chest.

4. Fibromyalgia

Fibromyalgia is one of the most common rheumatologic diseases, whose main symptom is generalized pain in various parts of the body, including the scapula. People who suffer from fibromyalgia often experience fatigue, muscle stiffness, tingling in the hands, and may also develop depression and sleep disturbances, leading to a worsening of quality of life.

When symptoms appear, it is important to consult a rheumatologist who will make the diagnosis through the history of pain, that is, the locations and duration of pain will be evaluated. However, the rheumatologist may order other tests, such as magnetic resonance imaging or electroneuromyography, to rule out other diseases.

What to do: Fibromyalgia is a chronic disease and has no cure, and treatment is based on pain relief. The rheumatologist may prescribe medications such as muscle relaxants such as cyclobenzaprine and tricyclic antidepressants such as amitriptyline. TENS and ultrasound techniques, used in physical therapy, can also help control the pain caused by fibromyalgia. Learn more about how fibromyalgia is treated.

5. Suprascapular nerve compression

The suprascapular nerve is located in the brachial plexus, which is the set of nerves responsible for shoulder and arm movements, and can undergo changes and cause severe pain in the scapula.

Compression of this nerve is an alteration caused mainly by inflammation or trauma, which can happen in accidents or in sports activities that put a lot of strain on the shoulder. However, suprascapular nerve compression can also be associated with cuff tear, better known as rotator cuff syndrome.See more about what is rotator cuff syndrome and how to treat it.

Scapular pain caused by compression of the suprascapular nerve can worsen at night and on colder days and when it is associated with other symptoms such as fatigue and muscle weakness, it is necessary to consult an orthopedist, who will indicate exams such as X-ray and MRI to confirm the diagnosis.

What to do: in milder cases, treatment is based on the use of anti-inflammatory and analgesic drugs to reduce inflammation and relieve pain, and physiotherapy. In advanced cases, the orthopedist may recommend surgery to decompress the suprascapular nerve.

6. Scapula fracture

Scapular fractures are rare, because they are resistant bones and with a lot of mobility, however, when it happens, it can cause pain. This type of fracture mainly occurs when a person falls and hits the shoulder, and often the pain appears some time later.

After an accident or fall that has generated trauma in the scapula region, it is necessary to seek care from an orthopedist who will request tests such as an X-ray to check for a fracture and, if there is, the doctor will analyze the extent of this fracture.

What to do: Most scapula fractures are treated through the use of pain-relieving medication, physical therapy and immobilization with a sling and splints, however, in more cases severe, surgery may be recommended.

7. Gorham's Disease

Gorham's disease is a rare disorder without a defined cause, which causes bone loss, causing pain in the scapular region. The pain in the scapula generated by this disease has a sudden onset, appears suddenly, and the person may have difficulty moving the shoulder. The diagnosis is made by an orthopedic doctor, through computed tomography and magnetic resonance imaging.

What to do: the treatment is defined by the orthopedic doctor, depending on the location of the disease and the symptoms presented by the person, and medications may be indicated to help replace the bone, such as bisphosphonates, and surgery.

8. Crackling Scapula Syndrome

The crackling scapula syndrome occurs when, when moving the arm and shoulder, a pop is heard in the scapula, causing severe pain. This syndrome is caused by excessive physical activity and trauma to the shoulder, being very common in young adults.

The diagnosis of this syndrome is made by the orthopedist based on the symptoms presented by the person and examinations such as X-rays or computed tomography may be recommended, if the doctor suspects other diseases.

What to do: Treatment consists of the use of analgesic and anti-inflammatory drugs to relieve pain and reduce inflammation, physiotherapy to strengthen the scapular muscles and kinesitherapy. Understand better what kinesitherapy is and which main exercises.

9. Liver and gallbladder problems

The appearance of gallstones and liver problems such as abscesses, which is the formation of pus, hepatitis and even cancer are he alth problems that can lead to pain in the scapula, especially on the right side.This symptom may also be accompanied by other signs such as yellowing of the skin and eyes, back pain, also on the right side, nausea, fever and diarrhea.

Some tests may be indicated by a general practitioner if you suspect that pain in the scapula region is caused by a liver or gallbladder disease, which may be ultrasound, CT scan, MRI or blood tests, for example example.

What to do: as soon as symptoms appear, it is recommended to look for a general practitioner to have tests done to confirm if there is a problem with the liver or gallbladder and after that, the doctor will be able to recommend the most appropriate treatment according to the diagnosed disease.

When to go to the doctor

Scapular pain can also be a symptom of other diseases that are not related to the bone, muscle or nervous system and, in some cases, can indicate heart and lung diseases, such as acute myocardial infarction and aneurysm of the pulmonary aorta.Therefore, it is important to seek urgent medical attention when other symptoms arise, such as:

  • Stinging pain in the chest;
  • Shortness of breath;
  • Paralysis on one side of the body;
  • Excessive sweating;
  • Cough with blood;
  • Pale;
  • Increased heart rate.

Furthermore, another symptom to be aware of is the development of fever which, when it appears, may indicate an infection and, in these cases, other tests may be recommended to discover the cause of this symptom.

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