Back and chest hurt at the same time: reasons, what to do

- a fairly typical localization of back pain, although it is much less common than, for example, lower back pain. The scapula is a flat bone, approximately triangular in shape, adjacent to the back of the chest in the area from the 2nd to the 8th rib. The shoulder blades tend to protrude slightly, forming the relief of the back, so we all know where they are and describe pain in relation to the shoulder blade if we feel it in the upper back to the right or left of the spine.

Pain in the shoulder blade area can be caused by various reasons. A simple indication of what hurts under the shoulder blade is not enough to determine what caused the pain, which means you cannot self-medicate without visiting a doctor and establishing the nature of the disease. At the same time, pain under the shoulder blade can be caused by very serious diseases, so if you experience severe or recurring pain under the shoulder blade, you should definitely consult a doctor. Don't expect the problem to go away on its own.

If you have pain under the shoulder blade, you need to pay attention to other symptoms, this will help the doctor make a diagnosis.

What is intercostal neuralgia?

Neuralgia of the intercostal nerves is pain of a different nature that occurs due to various etiological factors. It is more often observed in adult men and women over 30-35 years of age. Symptoms of neuralgia may appear suddenly on one or both sides of the chest, along one or more intercostal nerves. The disease has an ICD code - M.79.2.

To understand what intercostal neuralgia is, you should understand the anatomical features of the thoracic nerves. There are 12 pairs in total. Each intercostal nerve contains motor, sensory and sympathetic fibers. It originates from the anterior roots of the spinal cord of the thoracic spine, passes along the lower edge of each rib, reaching the sternum. The parietal pleura covers the nerve fibers on top.

Thoracic nerves transmit impulses to the skin, the musculo-ligamentous apparatus of the chest and the anterior wall of the abdomen, partly the pleura and peritoneum, and the mammary glands. Sensitive fibers of neighboring nerve trunks actively interact with each other, creating cross innervation.

How to distinguish intercostal neuralgia from heart disease?

If neuralgia has acute symptoms in the thoracic region on the left side, differential diagnosis with heart disease must be carried out. You should not look for the cause of the pain syndrome on your own. Thoracalgia on the left side should always be a reason to consult a doctor.

Heart pain and symptoms of intercostal neuralgia on the left have distinctive features:

Symptoms of intercostal neuralgia on the left and right should also be differentiated from other diseases (pleurisy, pneumonia, thoracic aortic aneurysm, pericarditis, acute pancreatitis and others). If there is severe pain in the chest, only a doctor can determine exactly what it is - neuralgia or another pathology.

What signs may accompany pain?

The symptoms accompanying back pain between the shoulder blades will help in diagnosing the real cause of the pain.

The back between the shoulder blades “sears, burns” - this combination of symptoms can be caused by: osteochondrosis of the cervical or thoracic spine; an attack of renal colic; biliary colic; reflux esophagitis.

A feeling of numbness in the back combined with pain between the shoulder blades can be caused by: osteochondrosis; humeroscapular periarthritis; kyphosis and kyphoscoliosis; spondyloarthrosis; coronary heart disease; biliary dyskinesia, peptic ulcer; pleurisy; pneumonia.

Itching of the back and pain in the interscapular area is a rather rare combination of symptoms. The cause of back pain can be biliary colic, as well as herpes zoster.

The back between the shoulder blades feels cold and hurts - a combination of symptoms can be caused by two diseases: pinched spinal nerve root and exacerbation of a disease such as chronic pyelonephritis.

An increase in temperature that accompanies pain between the shoulder blades is typical for pneumonia, pulmonary or bone tuberculosis, hepatitis, cholecystitis, pancreatitis and pyelonephritis.

Cough and back pain between the shoulder blades are symptoms characteristic of diseases of the bronchopulmonary system, such as pneumonia with pleurisy, tracheitis, tuberculosis, lung tumors.

Breathing heavily and your back hurts between your shoulder blades are definitely symptoms of lung damage, a manifestation of pneumonia and pleurisy.

A lump in the throat, combined with back pain between the shoulder blades, indicates that there are pathologies of the esophagus:

• inflammatory diseases,
• tumors
• cirrhosis of the liver with varicose veins of the esophagus.

Belching and back pain between the shoulder blades - this combination of symptoms indicates that the upper gastrointestinal tract is affected. Characteristic of peptic ulcer and cholelithiasis, gastroesophageal reflux.

Nausea and pain between the shoulder blades occur with peptic ulcers, with myocardial infarction, with subdiaphragmatic abscess, as well as with kidney diseases and liver disease.

The symptom of shortness of breath indicates that the condition is life-threatening and the patient urgently needs medical help. The combination of signs of shortness of breath and back pain in the area of ​​the shoulder blades is typical for pneumonia, pericarditis, and pneumothorax. Pain accompanied by shortness of breath, cough and hemoptysis, weakness and fever indicates that an urgent call to the doctor is necessary, rather than thinking about the origin of the pain.

Causes of intercostal neuralgia and risk factors

Intercostal neuralgia can develop for a variety of reasons. Among them are:

• injuries to the thoracic nerves, chest and spine;
• surgical interventions, long-term immobilization of a person in a certain position;
• poisoning with chemicals, prolonged use of medications;
• congenital developmental anomalies, hereditary diseases;
• infectious processes (shingles, tuberculosis, brucellosis and others);
• some neurological diseases, such as radiculitis and multiple sclerosis;
• diseases of the spine (osteochondrosis, deforming spondylosis, herniated intervertebral discs);
• compression of nerve branches in the bone-connective sheaths, for example, in the presence of scar changes, benign or malignant neoplasms;
• immunodeficiency (HIV infection, cancer, etc.);
• allergic reactions;
• diabetes;
• various metabolic disorders in nervous tissue and its hypoxia;
• lack of B vitamins in the body;
• alcohol abuse;
• osteoporosis;
• pathology of nearby anatomical structures (aorta, lungs, pleura);
• various systemic diseases (atherosclerosis, rheumatism, anemia, thyrotoxicosis, etc.).

More often, chest neuralgia appears due to several causes. Therefore, it is typical for older patients with vascular, degenerative and metabolic disorders. Sometimes symptoms of neuralgia appear after excessive physical activity, sudden movements or prolonged stay in one position. They can also occur after hypothermia or severe stress.

More often, intercostal neuralgia is observed on the left or right; less often, there is a bilateral lesion. In most cases, the pathogenesis is based on muscle spasm, leading to compression of nerve fibers. Pain occurs in response to nerve damage.

In children, signs of intercostal neuralgia are rare. When they appear, parents should definitely show the child to the doctor, as this may be a signal of the presence of a serious pathology. The doctor will determine the possible causes and explain how to cure intercostal neuralgia in this case.

Forms of the disease

Chest neuralgia can be primary (an independent pathology) and secondary (a symptom of another disease). There are also radicular and reflex forms of the disease. In the first case, symptoms of intercostal neuralgia on the left and right arise due to irritation of the spinal roots. The second type of pathology occurs due to a negative effect on peripheral receptors.

In addition, clinicians distinguish the following types of thoracic neuralgia:

• musculoskeletal;
• vertebrogenic;
• spicy;
• chronic;
• right-sided;
• left-handed;
• psychogenic;
• during pregnancy.

Intercostal neuralgia of a certain type has its own characteristic symptoms and treatment features.

Symptoms of neuralgia on the right and left

Any neuralgia, including intercostal neuralgia, is primarily pain. Painful sensations can be of a different nature (aching, dull, sharp, piercing, burning) and have different intensity. Sometimes the pain is so severe that it forces a person to take a forced position and sharply limit physical activity. Intercostal neuralgia, which has pronounced symptoms, is described by patients as a lumbago or electric current discharge running from the spine to the sternum.

Thoracalgia often begins gradually, with a tingling sensation in the intercostal spaces, then acquires pronounced intensity. Less often it occurs suddenly. The pain can radiate to the scapula, epigastric area, heart, arm and lower back. Sometimes it takes on an encircling character. It intensifies with changes in body position, movements, coughing and deep breathing.

As a rule, painful attacks are constantly repeated, lasting from a few seconds to 2-3 minutes. Therefore, treatment of acute intercostal neuralgia on the right and left, first of all, always begins with the elimination of pain.

In addition to thoracalgia, a person may be bothered by characteristic local signs caused by the influence of sympathetic, sensory and motor nerve fibers. Intercostal neuralgia, depending on the damage to a particular nerve, will have characteristic symptoms on the right, left or both sides of the chest:

• impaired sensitivity, crawling sensation, numbness, tingling;
• muscle twitching;
• increased sweating;
• change in skin color.

If chest neuralgia appears against the background of a herpes infection, it may be accompanied by skin rashes. The latter appear 2-4 days after the onset of thoracalgia. Elements of the rash are located on the skin of the intercostal space in the form of small pink spots, which then turn into vesicles and then into crusts. Subsequently, traces of pigmentation may remain on the skin.

Treatment

Treatment is selected depending on the diagnosis and may include both outpatient medication and hospitalization with surgery. The patient can also be prescribed and selected diet, physical activity and other measures for recovery, rehabilitation and reduction of symptoms and pain relief. The timing and number of treatment methods used are individual. If you have pain in the chest and back, go to the doctor. If you consult a neurologist

the problem can be solved either completely or the risk of complications and further health problems can be significantly reduced.

Diagnosis of intercostal neuralgia

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Acute intercostal neuralgia is a reason to contact a competent, qualified neurologist. Since symptoms in adults with damage to the thoracic nerves can be disguised as other diseases, the patient must undergo a comprehensive examination to exclude possible pathology. The doctor must conduct a survey and examination.

The person’s posture is noteworthy when he leans towards the healthy side, so as not to provoke a painful attack. Palpation of the chest reveals pain. Trigger points are identified at the lower edge of the rib, where the affected nerve passes. If neuralgia affects several nerve branches, which often happens, this leads to a decrease or complete loss of sensitivity in the corresponding area of ​​the body.

First of all, the doctor must distinguish the symptoms of intercostal neuralgia on the left from cardiovascular pathology. For this purpose, the patient undergoes an ECG. If indicated, a cardiologist is consulted. In order to correctly diagnose and treat intercostal neuralgia, the doctor also excludes diseases of the respiratory system, digestive tract, musculoskeletal system, infectious processes and other diseases. He may prescribe a number of additional tests (laboratory tests, x-ray of the lungs, ultrasound of the abdominal organs, MRI of the spine, etc.).

Thoracic neuralgia is an indication for electroneurography. This method allows you to determine the condition of nerve fibers by assessing their structure and functionality.

Chest neuralgia can be a manifestation of benign and malignant tumors. It is often the first symptom of a herniated disc and degenerative changes in the spine. Therefore, early identification of its causes is considered an important task for the neurologist and the patient.

Treatment of pain on the right side of the shoulder blade

Pain treatment must begin with diagnosis, since effective pain management is only possible if you know its cause. Symptomatic therapy based on the use of analgesics does not treat the cause of pain, but only temporarily alleviates the most severe symptom. After making an accurate diagnosis, it is possible to treat the underlying disease by influencing the factors that led to it.

This is also important because without knowing the cause of the pain, it is difficult to choose the right treatment. Thus, attempts to treat pain in the scapula on the right side with analgesics in acute cholecystitis can lead to complications in the form of gangrene of the gallbladder, its perforation and extensive peritonitis, with a high risk of death. Painkillers are strictly contraindicated for acute surgical diseases of the abdominal organs.

How to treat intercostal neuralgia?

Treatment of any neuralgia, including intercostal neuralgia, is aimed at eliminating the clinical manifestations and causes of the disease. Therapy includes a whole range of activities. If a patient is diagnosed with neuralgia, you can find out how to treat it from the specialists of our clinic. The doctor will select the optimal therapeutic course, taking into account the characteristics of the disease and the individual characteristics of the person.

As a rule, intercostal neuralgia requires long-term treatment and further measures to prevent painful attacks. The doctor prescribes specific methods of therapy, determines the duration of each course, and gives his recommendations on lifestyle and regimen. The treatment plan may include:

• painkillers;
• etiotropic therapy aimed at combating the underlying disease;
• anti-inflammatory drugs;
• neurotropic drugs;
• physiotherapy;
• osteopathy;
• massage;
• Exercise therapy.

The doctor always chooses how to treat neuralgia, based on the clinical picture, the stage of the process, the results of diagnostic examinations and the individual characteristics of the patient.

Is osteopathy effective for intercostal neuralgia?

The causes of neuralgia in the rib area can be different. However, in many cases, a pinched nerve is caused by the consequences of various injuries a person has received in the past. The capabilities of fine diagnostics using hands make it possible to identify and eliminate these disorders, which leads to the elimination of compression of the nerve and the restoration of its normal blood supply. As a result, inflammation and its integral companion – pain – go away. Osteopathy shows high effectiveness in the treatment of both unilateral and bilateral intercostal neuralgia.

Possible complications and consequences

Any neuralgia, in particular intercostal neuralgia, that does not respond to treatment, may be a sign of a serious illness. Most of the complications that arise with thoracalgia are precisely a manifestation of the underlying pathology, which worsens against the background of constant pain.

Chest neuralgia itself, with a long-term severe course, can provoke the development of a hypertensive crisis or an attack of angina (less often, myocardial infarction). Severe, constant pain affects a person’s physical and mental state in different ways. Often severe symptoms of intercostal neuralgia on the left or right significantly complicate the patient’s life. He sleeps poorly, is nervous, cannot move normally and do his usual work.

Pain in the intercostal spaces does not allow the patient to perform full breathing movements, which leads to a decrease in oxygen supply to the body and the development of hypoxia. Sometimes neuralgia is accompanied by such debilitating pain that it contributes to emotional exhaustion, and this is a serious complication, since this condition causes depression.

Factors contributing to pain between the shoulder blades

Painful sensations in the interscapular area can occur against the background of some vertebral pathologies:

• osteochondrosis of the thoracic region;
• problems with posture (kyphosis, scoliosis, kyphoscoliosis);
• spondyloarthrosis;
• humeroscapular periarthrosis;
• protrusion and intervertebral hernia in the thoracic region;
• intercostal neuralgia;
• radiculitis;
• spinal column injuries.

Problems in the functions of the spine can develop:

• during sedentary work;
• in the absence of sports;
• under significant loads for which the body is not ready.

More than one spine may be the source of the problem. Painful manifestations may occur against the background of disturbances in the functioning of internal organs. For example, the presence of cardiac pathologies: angina pectoris, coronary artery disease.

In addition, pain syndrome can develop against the background of:

• hepatitis A;
• cholecystitis;
• peptic ulcer in the stomach;
• pulmonary diseases;
• infectious pathologies.

Often, people who move little due to the specific nature of their work activity have to face a similar problem, since their muscular and ligamentous systems are weakened, and the muscle fibers in the shoulder girdle are tense for a long time. Such pain often bothers drivers, garment factory workers, etc.

Neuralgia during pregnancy

If intercostal neuralgia appears in a pregnant woman, how to diagnose it and how to treat it is decided by a neurologist together with a gynecologist. Therapy is selected taking into account possible negative effects on the fetus. Self-medication in this situation is considered unacceptable, as this can have a negative impact on the health of the expectant mother and child.

To prevent chest neuralgia from appearing during pregnancy, it is advisable to follow preventive measures. If a woman has previously had attacks of thoracalgia, then at the stage of preconception preparation she should visit a neurologist and osteopath. The doctor will conduct a diagnosis, and then the neurologist will give a number of recommendations on how to treat intercostal neuralgia. An osteopath will identify possible causes of neuralgia and conduct a treatment session aimed at eliminating them.

Effective therapeutic techniques

After determining the root cause of interscapular pain, the patient may need to consult with a cardiologist, neurologist, or gastroenterologist. Until you receive medical help, you can try to relieve the pain syndrome on your own; you should not endure it for long. There are some harmless methods to relieve pain.

Gymnastic exercises

A gymnastics complex will help relieve discomfort:

• We place our palms on our shoulders and perform several circular movements back and forth.
• We raise our palms to the top, then our arms completely, lock them together, lower our heads, and concentrate our gaze on the fingers.
• We bring and spread the shoulder blades.
• We perform body turns alternately to the right and left.

Medicines

Taking medications without medical advice is contraindicated, as this may worsen the situation.

In cases where the cause of pain in the intervertebral region is associated with spinal diseases, the doctor may prescribe treatment with drugs from the NSAID group:

• Diclofenac;
• Indomethacin;
• Movalis;
• Ibuprofen;
• Nimesulide;
• Meloxicam;
• Naproxen;
• Voltaren, etc.

As an auxiliary therapy, the affected area can be treated with external agents: Fastum gel, Capsicam, Amelotex, Nise gel.

After the pain has eased, you can resort to local medications with an irritating effect:

• Efkamena;
• Menovazina;
• Finalgona.

Forecast and prevention of intercostal neuralgia

In most patients, intercostal neuralgia can be completely cured. If thoracalgia occurs against the background of a herpetic infection, relapses are possible.

If adequate treatment of neuralgia does not bring the desired result, a more “deep” diagnosis is carried out to search for the possible cause of this condition. First of all, spinal hernias, benign and malignant tumors are excluded.

To prevent neuralgia of the intercostal branches from recurring, and its symptoms in adults to manifest themselves less painfully, doctors recommend the following preventive measures:

• follow the canons of a healthy lifestyle: give the body adequate physical activity, eat right, actively relax in the fresh air, give up bad habits, etc.;
• maintain normal functioning of the immune system;
• monitor posture and spinal health;
• promptly treat chronic diseases and infectious processes;
• if possible, visit the pool and harden yourself;
• undergo preventive examinations on time;
• undergo regular scheduled examinations by an osteopath approximately once every six months.

If a person has previously had thoracic neuralgia, he should not be overcooled, be in a draft, expose the body to excessive physical stress, perform sudden movements or remain in an uncomfortable position for a long time. In addition, it is necessary to eliminate or minimize as much as possible stress and any unfavorable factors that can cause symptoms of intercostal neuralgia on the left, right or both sides.

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Adviсe

Since the cause of pain is often spinal diseases, in order to keep the spine healthy, it is recommended:

• try not to stay in one position for a long time;
• play sports (but in moderation);
• avoid hypothermia;
• ensure uniform load distribution;
• do not strain muscle tissue too much;
• ensure that your diet is balanced.

Pain in the interscapular area can indicate the development of many diseases. This can be either a disease of the spinal column or problems with internal organs. It is impossible to determine the source of the problem on your own. To do this, you need to consult a doctor, undergo an appropriate examination and begin treatment prescribed by the doctor.