Subscapularis muscle functions. Subscapularis tendon rupture

The human body is inherently unique. Everything in it is thought out to the smallest detail. Each muscle, each cell performs its specific work. And only thanks to this a person can fully exist. Now I would like to talk about what the subscapularis muscle is and what its main function is.

Definition of concepts

Initially, you need to understand the basic terminology. So, what is the subscapularis muscle? According to the medical dictionary, the Latin name for this part is human body sounds like m. Subscapularis. It belongs to the belt group. It originates from the anterior surface of the scapula, which is also called the costal surface. It is attached to the tubercle located on

Main function

Why the subscapularis is needed is very simple. However, without their implementation, a person will not be able to fully live and carry out his daily work. So she:

• brings the shoulder to the human body;
• helps the shoulder rotate inward.

However, its main task is to help stabilize its work during shoulder movements. It is indispensable for the proper functioning of the entire shoulder girdle.

Appearance

The subscapularis muscle is triangular in shape and flat. Consists of multiple bundles. It is important to note that there are special layers between these bundles, which makes this muscle very unique and different from others. It also has two layers:

1. Deep. Starts from the costal surface of the scapula. However, the shape does not coincide with it a little, as it seems slightly offset.
2. Surface. It is located from the subscapular fascia, where it is securely attached to the edges of the subscapular fossa.

Feeling (palpation)

In addition to the subscapularis muscle, the so-called rotating ring includes three more: teres minor, cavitary and supraspinatus. It is because of this that it is very, very difficult to palpate the subscapularis muscle. Not only is it part of a larger complex, but it is also located on the front of the scapula. That is, it fits tightly to the chest. Only a specialist can palpate it. To do this you will have to perform a number of actions:

• The patient should lie either on his stomach or on his back.
• The patient's arm is moved to the side as far as possible.
• You need to “walk” under the back wall with your fingers, while feeling the edge of the scapula.
• Moving medially, you can palpate the subscapularis muscle. In this case, it must be pressed against the front wall of the shoulder blade.

Doctors say that the muscle cannot always be detected. Much depends on the ability of the patient's scapula to move relative to chest.

About pain

Damage to the subscapularis muscle is always associated with unpleasant sensations. So, a person can feel discomfort not only in the place where it is located. The pain may be concentrated in the area where the muscle is located, or may spread to the entire shoulder blade. But it also happens that discomfort appears even in the wrist area. It is in this place that they are encircling in nature. Also discomfort may occur in the event of an attempt to abduct the shoulder to the side or move it outward. Pain can result from the most common causes:

• severe load on the shoulder when turning inward, especially if the load is regular. This problem, for example, often occurs in crawl swimmers;
• Shoulder injuries of various nature can also be the cause.

About problems

What problems can arise when it comes to this part of the human body? The first problem is subscapularis tendinopathy. These are some that arise as a result of insufficient blood supply to the muscles. The cause of tendinopathy can also be hereditary pathologies connective tissue. It should be noted that, for example, with tendinopathy of the subscapularis muscle, a person’s pain intensifies when he brings a spoon to his mouth, combs his hair, or moves his arm behind his back. It should be noted that if a patient often has similar problems relating to the muscles of the shoulder girdle, then he may be diagnosed with “humeral periarthritis”. This problem can also arise in case of permanent tendon injury.

About breaks

Rupture of the subscapularis muscle does not occur very often. However, the cause most often is tendinopathy, which arises as a precursor to this problem. Symptoms of a subscapularis tendon rupture:

• sudden increase in pain;
• inability to move your arm freely.

It is also important to note that ruptures can be either partial or complete, where the tendon is completely torn from its attachment. The intensity of pain, of course, depends on this. With partial ruptures, movement of the hand may still be preserved (although it will be accompanied by pain), while with complete ruptures the hand is completely immobilized.

Diagnostics

Only a doctor can diagnose the problem. This will require examination of the patient and collection of anamnesis. The patient will also be sent for an x-ray. To clarify the extent of damage, you will have to undergo an ultrasound examination or MRI.

Treatment

How is the subscapularis muscle treated? Most often it is conservative. The main thing with a partial tendon rupture is to relieve the pain. For this purpose, painkillers and anti-inflammatory drugs may be prescribed. Also, the sore spot is fixed with a tight bandage. If a tendon ruptures, a splint may be used. When the pain goes away and the shoulder returns to normal, the doctor prescribes special exercises to develop the joint.

Sometimes surgery is required. This is most often necessary in cases of complete tendon rupture, or if conservative treatment has not produced the desired results.

The so-called frozen shoulder syndrome, accompanied by pain and limited mobility in the shoulder joint, can be a consequence of various injuries and disorders. Often this problem occurs due to overstrain of the subscapularis muscle. That is why in this article the site will tell you how to localize trigger points of the subscapularis muscle, what symptoms are characteristic of their appearance, as well as ways to eliminate pain caused by muscle strain.

Subscapularis muscle: location and main functions

The very name of the subscapularis muscle ( m. subscapularis) indicates its location - the muscle is located under the scapula, between the rib cage and the scapula bone. The muscle passes laterally and is attached to the anterior part of the humeral head of the shoulder joint.

When the subscapularis muscle contracts, the arm rotates inward and is brought toward the body. As one of the rotator cuff muscles, the subscapularis muscle supports the shoulder joint during movement, especially when the humeral head tends to slide upward during abduction.

Below we will look at:

• subscapularis trigger points and referred pain patterns;
• reasons for the appearance of trigger points of the subscapularis muscle;
• subscapularis trigger point symptoms;
• self-massage of the subscapularis muscle to eliminate pain.

As one of the rotator cuff muscles, the subscapularis muscle supports the shoulder joint during movement.

Subscapularis Trigger Points and Referred Pain Patterns

The subscapularis muscle can become the site of up to three trigger points, two of which usually appear near the outer edge of the muscle. Fortunately, a trigger point on the inner edge of the muscle is much less common because it is almost impossible to palpate and eliminate manually.

The main symptoms that accompany the presence of trigger points in the subscapularis muscle

The activity of trigger points in the subscapularis muscle can lead to the following symptoms and complaints:

• severe pain in the back of the shoulder, which can appear during movement or immobility of the shoulder and is localized quite deeply;
• inability to raise the arm more than 45 degrees - severe pain occurs when trying to raise the arm to the side;
• pain intensifies when trying to touch the armpit located under the other arm;
• frozen shoulder syndrome, or adhesive capsulitis: pain in the shoulder area, limited mobility in the shoulder joint.

Pain in the shoulder, under the shoulder blade, in the upper arm and around the wrist are possible symptoms of a strained subscapularis muscle.

A quick guide to self-massage of the subscapularis muscle

To massage the subscapularis muscle, it must first be localized. To do this, sit in a chair or lean forward, lower one arm down and relax it so that it dangles freely.

Place your other hand in the armpit and begin to rotate your shoulder inward - during this movement you will feel the subscapularis muscle. Remember that this area is very sensitive because it contains large number nerves. Feel the muscle contract, then relax it and begin the massage.

Make sure you only massage the muscle and not the nerves, as this can lead to armpit pain. You should massage the subscapularis muscle with your thumb, slowly moving it over the sensitive points of the muscle.

Another massage option is a pressure motion: apply pressure right hand on the muscle located on the left side, and then perform various movements with your left hand (lift, rotate it).

The glenohumeral ligamentous-cartilaginous complex (the glenohumeral ligaments with the cartilaginous labrum) is to some extent a passive stabilizing apparatus of the shoulder joint. Although the labrum increases the depth of the glenoid cavity of the scapula, its role as a mechanical barrier against subluxation is much less important than its role as a substrate for the attachment of the glenohumeral ligaments. Because both the lip and ligaments are composed of dense, interwoven collagen fibers, the likelihood of damage to the lip-bone connection (labral avulsion) is greater than the likelihood of a tear anywhere in the ligamentous-cartilaginous complex.

Rice. Shoulder-scapular ligaments. A - schematic view of the joint from the front. B - view of the ligaments on axial sections, C - schematic view of the joint from the side. LHBT - long head of biceps tendon, CHL - coracohumeral ligament, SGHL - superior glenohumeral ligament, MGHL - middle glenohumeral ligament. IGHL - inferior glenohumeral ligament.

Other development options concern the anterior-superior parts of the lip, where there is separation of the lip from the scapula (sublabial foramen) or congenital absence of the lip (Buford complex).

Rice. Variants of development of the anterior sections of the fibrous lip.

Tendon ruptures, degeneration and dislocation

Degenerations and partial ruptures of the tendon.

T1 shows a local or diffuse increase in signal intensity. At T2, degeneration has a signal intensity closer to that of normal muscle.

If the signal from the tendon is closer in intensity to water, then one should think about partial damage. There are times when it is really difficult to draw the line between rupture and degeneration. In these cases, changes in the tendon are described by the term tendinosis or tendinopathy.

The changes are local rather than diffuse in nature and have a specific localization (1 cm proximal to the attachment of the supraspinatus tendon to the greater tubercle).

Most often, the lower surface of the distal portion of the supraspinatus tendon undergoes partial rupture.

Early detection of pathological changes in the tendon at the stage preceding complete tendon rupture is of great clinical importance, since in this case treatment is conservative or limited to surgical debridement or decompression.

With a complete rupture of the tendon, a limitation in the range of motion is added to the pain syndrome, which requires more radical surgical treatment.

Complete tendon rupture

The direct criterion for a complete tendon rupture is the disruption of the continuity of the tendon structure by a highly intense signal from the fluid that fills the gap between the ends of the damaged tendon.

Secondary signs of complete tendon rupture:

• medial mixing of the musculotendinous junction, which is normally located at the 12 o'clock position of the humeral head or lateral to the gap;
• acromioclavicular joint;
• local thinning, unevenness and blurring of the tendon edges;
• atrophy of the supraspinatus muscle with fatty degeneration;
• the appearance of fluid in the subacromial-subdeltoid space.

Long head of biceps

A complete tear of the long head of the biceps occurs in approximately 7% of patients with a supraspinatus muscle tear, and one third of patients have degeneration or partial tears.

With a complete rupture of the tendon, to which the proximal critical zone is more susceptible, the distal fragment of the tendon can move out of the bone recess due to muscle traction, which is clearly visible on axial sections. Such ruptures are more common in older people. In young people, complete ruptures of the tendon of the long head of the biceps are observed distal to the bone recess, somewhere at the level of the muscle-tendon junction.

Acute trauma can also cause avulsion, subluxation, or dislocation of the tendon, requiring reconstructive intervention. Required condition for a tendon dislocation or subluxation is a rupture transverse humeral ligament, stretched between the greater and lesser tubercles and holding the tendon of the long head of the biceps in the bony cavity.

When dislocated, the tendon moves anteriorly and medially. If the tendon is not identified in the bone recess, this already indicates the presence of pathology. Typically, the tendon is displaced anteriorly and medially from the bony recess to varying distances under or above the subscapularis tendon.

Infraspinatus muscle

Rupture of the infraspinatus tendon due to acute trauma can occur alone or in combination with a rupture of the supraspinatus muscle. Also, the cause of the rupture may be impingement of the shoulder in the posterior-superior sections. The latter condition concerns mainly the entrapment of the infraspinatus tendon between the head of the humerus and the posterior edge of the labrum when the arm is abducted behind the head with external rotation (for example, when throwing).

In addition to the tendon of the infraspinatus muscle, the postero-superior parts of the fibrous articular labrum are subject to changes, as well as the head of the humerus at the point where the indicated edge of the articular labrum is pressed into it.

Clinical manifestations include posterior shoulder pain and sometimes anterior subluxation.

Morphology:

• degenerative cysts in the posterior part of the head near the insertion of the infraspinatus tendon;
• dislocation, partial or complete rupture of the tendons of the infraspinatus and/or supraspinatus muscles;
• disintegration or rupture of the posterior fibrous labrum.

Subscapularis muscle

Rupture of the subscapularis tendon is a relatively common occurrence. It can occur as a result of a fall on an adducted arm in a state of hyperextension or due to external rotation, it can also accompany anterior shoulder dislocation, significant rotator cuff injuries and biceps tendon dislocation, or be a consequence of subcoracoid impingement.

The latter condition is accompanied by a narrowing of the space between the tip of the coracoid process and the head of the humerus, both congenital and as a result of a fracture of the coracoid process or surgery.

A rupture can be recognized by interruption of the tendon, a diffuse increase in the signal from its structure, changes in the thickness of the tendon and its position, and the flow of contrast material between the damaged fibers.

Additional criterion: atrophy of the subscapularis muscle with its fatty degeneration.

Multiple rotator cuff injuries

Multiple rotator cuff tears typically occur in older patients with advanced tendon degeneration and predisposing factors such as arthritis, diabetes, or long-term hormonal therapy.

As a rule, there is always a complete rupture of the tendons with displacement of the musculotendinous junction and atrophy. It is also typical to have large communications between the joint cavity and the subacromial synovial bursa. Sometimes quite large synovial cysts form, protruding under the skin.

IN acute period Blood can be detected in the joint cavity, and in the long term - fibrosis and calcification. Quite characteristic bone changes include upward displacement of the humeral head with the formation of neoarthrosis of the humeral head and the lower surface of the acromion process, as well as degenerative changes in the humeral head itself with subcortical cysts and marginal osteophytes.

Rotator interval

The rotator cuff interval is the triangular-shaped space between the supraspinatus and subscapularis tendons. The base of this triangle is the coracoid process, the upper and lower sides, respectively, of the supraspinatus and subscapularis tendons, and the apex is the transverse humeral ligament, which forms the roof for the bicipital groove. The tendon of the long head of the biceps passes through this space. This space is considered the most favorable entry point into the joint when performing arthroscopy.

Disturbances in this interval may be due to anterior joint dislocation or congenital instability, or may also result from surgical intervention.

Instability

Instability is a dislocation or subluxation of the shoulder that occurs with or without injury. After impingement syndrome, instability of the shoulder joint is the most common type of pathology encountered. These two conditions often coexist.

This very painful condition can be difficult to diagnose unless there is evidence of an acute episode.

The stability of the shoulder joint depends on a whole complex of bone and soft tissue structures surrounding the joint.

Factors predisposing to joint instability are:

• abnormalities of the articular labrum,
• weakening or rupture of the joint capsule,
• weakness or damage to the glenohumeral ligaments,
• flat glenoid cavity of the scapula or its other developmental anomaly,
• Hill-Sachs or Bankart fractures from a previous dislocation.

Clinically, instability of the shoulder joint can be divided into 2 types:

• functional instability- The joint remains stable on physical examination, but the patient reports clicking, pain, transient blocking, and a subjective feeling of instability. These patients often present with labral injuries that cause pain in the absence of clinical evidence of instability.
• anatomical instability - recurrent dislocations or subluxations and on physical examination they show signs of instability.

Depending on the direction of displacement, there are 4 types of dislocation: front (95%), rear And mixed.

Another type of mixed dislocation is called superior displacement of the humeral head, accompanied by entrapment syndrome and neoarthrosis in the subacromial joint.

Secondary changes in dislocation:

• hypertrophy of the greater tuberosity,
• formation of subacromial exostosis,
• thickening of the coracoacromial ligament
• formation of exostosis in the glenohumeral joint.

In some patients, instability develops as a result of a previously recognized traumatic dislocation; in others, no evidence of injury is found. Increased elasticity of the anterior supporting elements of the joint develops. A congenital anomaly may be added to this.

Predisposing factors are:

• insufficient depth and radius of curvature of the glenoid cavity of the scapula or an unusual angle of its position;
• congenital increased elasticity of the capsule and ligaments,
• insufficient development or complete absence of the glenohumeral ligaments,
• the third type (medial) of attachment of the joint capsule.

Damage to joint elements due to dislocation

Lesions of the lip, capsule, glenohumeral ligaments and bones. Various combinations of lesions of these structures are possible.

The third type of capsule attachment, its defects, unevenness, and separation from the edge of the scapula indicate anterior instability of the joint.

Traumatic anterior shoulder dislocations may also be accompanied by rupture of the subscapularis tendon with widening of the subscapularis recess. The posterior layer of the capsule undergoes similar changes during posterior dislocation of the joint.

Common injuries to the joint capsule include Bennett's defeat, which is a non-articular cavity-related injury to the posterior layer of the capsule and posterior lip. Typically seen in baseball pitchers. The biomechanics of this injury is caused by overstretching of the posterior bundle of the inferior glenohumeral ligament during the final braking phase of the throw.

A rupture not detected in a timely manner leads first to functional and then to anatomical instability of the joint.

The most common MRI manifestation of joint instability is rupture, thickening, or absence of any of the glenohumeral ligaments. Most often, with a dislocation, damage to the inferior glenohumeral ligament, the main stabilizer of the shoulder joint, is observed. It can occur anywhere in the ligament. The most common injury associated with a shoulder dislocation is a tear of the ligament at its attachment to the shoulder, which is often associated with a rupture of the subscapularis tendon. It is usually manifested by an increase in the signal intensity from the ligament in T2, interruption of its structure in the area of ​​attachment to the anatomical neck, waviness of the contours of the fragment, and its downward displacement.

Bone changes

Bone changes accompanying instability can be of either acquired or dysontogenetic origin. Congenital tilt, rotation, or flatness of the glenoid cavity of the scapula predisposes to the development of instability.

Hill-Sachs fracture- anterior dislocation leads to acquired bone deformity from a depressed fracture of the posterolateral part of the head. This fracture can be visualized as a depression of the bone surface.

It should be remembered that the head of the humerus in sections cranial to the coracoid process should always be rounded. Below this level, flattening of the head is acceptable.

Bankart fracture- a fracture of the anterior-inferior edge of the glenoid cavity - anterior dislocation of the humeral head can also be accompanied by it.

Posterior dislocation of the shoulder can lead to a compression fracture of the anterior internal part of the head and posterior part of the glenoid cavity and the posterior edge of the glenoid cavity - reverse Bankart fracture.

Lip

There are many options for damage to the fibrous cartilaginous labrum: full- and partial-thickness tears, separation from the edge of the glenoid cavity, crushing and crushing.

There are 2 types of lip damage accompanying joint instability:

• Bankart damage
• anterior subperiosteal avulsion of the ligament-cartilaginous complex (ALPSA).

After anterior shoulder dislocation, Bankart injury is the most common injury to the shoulder joint. It consists of separating the anterior lower lip (with or without rupture) from the glenoid cavity of the scapula with rupture of the periosteum of the scapula. This injury may also be accompanied by a fracture of the anterior inferior glenoid cavity.

A type of Bankart injury is a subperiosteal avulsion of the anterior lip. It is characterized by a separation of the cartilaginous lip along with detachment of the periosteum without damaging the latter.

In this case, the lip, which is exfoliated along with the periosteum, can be wrapped under the neck of the scapula and heal in such a position, which is fraught with the development of chronic instability.

Thus, these two injuries differ only in the condition of the periosteum. In the case of Bankart it breaks, in the alternative it peels off.

Rice. Damage to the lip. Scheme of axial section of a normal cartilaginous labrum, as well as key features of Bankart injury, anterior subperiosteal avulsion of the fibrocartilaginous complex (ALPSA) and glenolabral tear (GLAD)

For healing, the latter is considered a more favorable option. Clinical management differs, so it is important to try to differentiate the two lesions on MRI.

A reverse Bankart injury results from posterior dislocation in response to repetitive abduction and internal rotation. In this case, the posteroinferior edge of the articular labrum is separated with or without a fracture of the posterior edge of the glenoid cavity.

The criterion for diagnosing lip damage is the linear hyperintensity of the signal (more intense than from hyaline cartilage) in the thickness of the articular labrum, extending to its surface. When the lip is crushed, the signal from it diffusely increases. A missing or disproportionately small lip should also suggest damage. And finally, the separation and displacement of the lip beyond the edge of the glenoid cavity should not raise any doubt about the damage.

Lip injury not associated with joint instability

Such injuries include injuries to the anterior, upper and posterior lips, lip cysts, and glenolabral tears.

SLAP refers to any tear of the labrum closer to the anterior or posterior edge. These injuries affect the attachment of the long head of the biceps to the upper lip. The mechanism of injury is compression when moving the hand behind the head, in which the lip becomes pinched between the head and the edge of the glenoid cavity, or traction from the side of the long head of the biceps, leading to separation of the upper lip. Patients complain of pain, blocking of movement, clicking, and a feeling of instability, although the joint remains stable on examination.

Initially, SLAP injuries were divided into 4 types:

• Type 1 - fibering of the free edge of the upper lip;
• Type 2 - separation of the upper articular labrum from the edge of the cavity;
• Type 3 - tear like the handle of the upper lip with extension to the tendon of the long head of the biceps;
• Type 4 - a tear like a watering can handle, extending to the tendon of the long head of the biceps.

Rice. Anterior and posterior tears of the upper lip.

The clinical significance of this classification can also be questioned, since treatment tactics mainly depend on the presence or absence of a rupture of the tendon of the long head of the biceps. Thus, the most important thing for the MRI specialist is to be able to describe the condition of the labrum and tendon of the long head of the biceps, rather than trying to clearly classify a SLAP injury.

Lip fibering is manifested by uneven edges and a diffuse increase in signal from the upper lip.

An avulsion of the labrum appears as a hyperintense linear signal separating the labrum from the articular edge of the scapula. This defect extends anterior and posterior to the insertion of the tendon of the long head of the biceps, in contrast to the sublabial foramen.

When avulsed, the lip is completely separated from the bone by a highly intense line of fluid extending beyond the area of ​​attachment of the biceps tendon. The SLAP tear strip extends from the substance of the upper lip in a craniocaudal direction to its lower surface or covers the entire lip, dividing it into lateral medial fragments. In the latter case, the gap is called the “watering can handle” type.

Clavicle fracture and acromioclavicular joint rupture

Fracture of the greater tuberosity of the humerus

Impacted fracture of the surgical neck of the humerus

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The shoulder joint is one of the largest and at the same time most mobile joints in the human body.

Movements in the shoulder joint can be carried out in all three planes: frontal, sagittal and vertical. This mobility is largely provided by the rotator cuff, which is formed by the tendons of four muscles: the subscapularis, supraspinatus, infraspinatus and teres minor.

The subscapularis muscle is directly responsible for adduction and pronation of the shoulder.

Damage to the subscapularis tendon is accompanied by impaired function of the upper limb and the inability to fully carry out movements.

Causes of subscapularis tendon rupture

In most cases, subscapularis tendon rupture does not occur spontaneously. This is a chronic process that develops against the background of degenerative changes in the tendon, constant microtrauma and deterioration of blood supply.

The greatest risk of injury is for middle-aged amateur athletes who engage in weightlifting, badminton or swimming. It is in these sports that the athlete is required to frequently change the position of the shoulder relative to the shoulder joint, which provokes the occurrence of a rupture.

However, rupture of the subscapularis tendon can also occur due to severe trauma without the presence of predisposing factors.

If the first symptoms of injury appear (pain in the shoulder joint, limitation or complete inability to move the arm, swelling and redness in the shoulder area), you should immediately seek medical help.

The addresses of sports clinics that we are confident in are listed at the end of the article.

Subscapularis tendon rupture: treatment

Treatment of injury is carried out conservatively or with surgery. Surgical treatment is indicated in cases of complete tendon rupture, as well as in situations where conservative treatment has been ineffective.

Exercise therapy for rupture of the subscapularis tendon is actively used in the postoperative period to restore limb function.

Consultation with a sports doctor

A visit to a sports doctor is one of the main stages on the path to returning to sports after an injury.

The best sports clinics and doctors!

1. Dr. Chechil’s manual therapy clinic

Chechil Sergey Vyacheslavovich— Chief physician of the clinic. The main direction is the musculoskeletal system. He has 24 years of medical experience: managing the medical service of a nuclear submarine, managing the special training department of the Paratunka military sanatorium in Kamchatka.

Kovtun Yuri Vadimovich— Neurologist, chiropractor, specialist in the selection and installation of orthopedic individual insoles. Certified Kinesto Taping Specialist.

Clinic video

Clinic website - www.chechil.com

2. Moscow Scientific and Practical Center for Sports Medicine

— Traumatologist-orthopedist of the traumatology department.

Clinic website - mnpcsm.ru

3. Family Clinic

Davis Andrey Evgenievich— Traumatologist-orthopedist. Doctor of the highest category.

Clinic website - Semeynaya.ru

The company "Sport-TEK" - for painless amateur sports!

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Pain in the back is the most common symptom among patients' complaints. There are many factors causing this syndrome. The main causes are often chronic diseases of the musculoskeletal system, bruises, injuries, and sprains.

Among all types of back injuries, muscle strain is distinguished - this is a serious injury. muscle tissue and ligaments, caused by severe stress on the spine. The disorder occurs as a result of heavy lifting, intense physical activity, sudden movements, prolonged stay of the body in an incorrect position, is accompanied by severe pain and a general deterioration in the patient’s condition.

What to do if you pulled a muscle in your back? When pain occurs, first of all, it is necessary to provide the patient with bed rest and find out the causes of the problem in order to make an adequate decision regarding treatment.

Muscle strains are possible in every part of the spine. More susceptible to pathology lumbar region, due to the volume of load placed on it. The causes of damage are:

• sedentary work, inactivity;
• weakness and underdevelopment of the muscular system;
• unpreparedness for lifting heavy loads, improper distribution of weight on the back;
• bruises, wounds;
• active sharp physical training;
• neurological diseases;
• performing exercises without warming up and preparing muscles;
• nervous tension, stress;
• acute viral infections.

A serious cause of sprains lies in the displacement of the spinal discs as a result of excessive stress. Changes in the spine lead to pinched nerves, causing very severe pain that spreads to neighboring organs and muscles.

Unpleasant symptoms of the disease can occur regardless of training and degree physical training person. Even an unsuccessful fall, a jump, or a sharp turn of the body can be the cause of the pathology.

What ointments help with sprained muscles and ligaments?

Symptoms of back strain and severity of sprains

The expression “off your back” is a frequently used phrase in conversation that may indicate a number of spinal injuries:

• sprains;
• ligament ruptures;
• osteochondrosis;
• hernias

The following signs will help make an accurate diagnosis:

1. Unbearable pain at the site of injury, radiating to the legs, occurs after physical activity. IN supine position the pain calms down and goes away over time.
2. It is impossible to straighten your back due to severe nagging pain.
3. Difficulty moving, muscle tension, spasms.
4. Loss of sensitivity of the affected area, swelling, “pins and needles” in the fingers of the extremities.
5. When vertebrae or nerves are damaged, external disorders of the spine are sometimes visible and malfunctions in the functioning of internal organs are observed.

There are 3 stages of muscle deformation:

1. Not pronounced, tolerable pain syndrome, goes away on its own within 3 days.
2. Intense pain, accompanied by muscle contraction, causes serious discomfort in the back. It is necessary to consult a doctor to determine treatment tactics.
3. Very strong, sharp pain caused by rupture of the back muscles leads to difficulty moving. Urgent medical attention is required.

Learn how to treat a groin sprain.

First aid for back strain

In case of a sprained lower back muscle, it is important to consult a specialist as soon as possible to prevent complications. Self-treatment is dangerous.

If medical assistance cannot be provided due to any circumstances, it is necessary:

• put the patient on a hard, flat surface, ensure that the injured area of ​​the back is immobile;
• if necessary, reduce pain with painkillers;
• you can take anti-inflammatory drugs;
• relieve swelling and stop the spread of the inflammatory process with ice compresses (apply ice through a cloth to the damaged areas for half an hour);
• Do not heat the sprained area or use warming ointments;
• massage is prohibited;

The recovery process of injured muscles takes a long time, depending on the complexity and nature of the injury. Treatment methods can include both drug therapy and surgery. That's why, it is very important to provide first aid correctly and consult a doctor in a timely manner.

Diagnostics

The doctor must make a diagnosis and determine the degree of sprain, based on the patient’s complaints and examination data. Depending on the type and location of pain, conclusions are drawn about the presence or absence of complications of the injury.

If the pain has spread to neighboring tissues, extends to the legs, buttocks, then instrumental diagnostics are prescribed - x-rays, computed tomography, and in some cases MRI.

How to treat a hip sprain?

Treatment

If the symptoms of a back muscle strain are minor, no treatment is required. In such cases, a mild pain syndrome does not cause discomfort to the person and does not disrupt his usual way of life. But damage does not always go away without consequences; failure to provide proper treatment and preventive measures in a timely manner can lead to complications in the course of the disease.

How to treat a back muscle strain

Drug therapy is most often used as treatment - anti-inflammatory non-steroidal drugs, painkillers, and B vitamins are prescribed. The drugs are prescribed in tablets and injections.

In total it gives good result use of ointment for stretching back muscles. Compositions that have an anti-inflammatory effect can be used immediately after injury, and with a warming effect only after swelling and inflammation have been removed. As a rule, such treatment is sufficient for a course duration of 2 weeks.

In case of displacement of the vertebral discs, additionally prescribed manual therapy. As a reinforcement positive dynamics drug treatment, the patient is prescribed laser therapy or physiotherapy, it is recommended to undergo a course of massage, exercise therapy (physical therapy). In case of rupture of the spinal muscles, urgent surgical treatment is required, the need for which is determined by the doctor.

All back muscles are subject to deformation, but fewer cases of sprain occur in the thoracic spine, namely under the shoulder blades.

If a person has pulled a muscle under the shoulder blade, the following treatment will be required:

• good rest is necessary;
• taking anti-inflammatory drugs;
• for muscle spasms, medications are used that reduce muscle tone (muscle relaxants);
• for chronic pain combined with a depressive state, take antidepressants;
• physiotherapy, massage.

What to do if an ankle ligament ruptures or sprains?

Exercise therapy

Therapeutic exercise is a method of treatment and rehabilitation, which is a set of exercises individually selected for each patient, aimed at restoring human health.

Exercise therapy improves general condition body, restores performance, increases immunity, reduces pain, helps strengthen muscles and ligaments. The necessary set of exercises is developed by the doctor, taking into account all the features of the course of the disease.

Massage

I am one of the most effective methods treatment of muscle strain. You can start a massage course as early as 2 days after receiving the injury. The first days the procedure involves a light impact on the tissues located next to the injured area; on the 4th day and beyond, the technique changes and the impact begins directly on the site of injury.

Massage improves blood circulation, helps relax and increase the elasticity of the back muscles, rapid recovery damaged tissues.

Laser therapy– a type of physiotherapy that involves exposing the painful area to infrared radiation. The main advantage of the method is the ability of the laser to penetrate deep into the body to the required treatment site.

This effect has a strengthening effect on the spine, helps eliminate pain, relieve inflammation, and normalize muscle function.

Electrophoresis is a method of physiotherapy that involves introducing medication into damaged tissues using current. As a result, there is an improvement in the condition of the whole body, relief of tension and restoration of muscle mobility.

Rehabilitation

After completing a course of treatment for a sprained spinal muscle, it is necessary to follow certain rules for 1.5-2 months to prevent re-injury and complete recovery of the body:

• exercise regularly;
• if a serious load on the spine is expected, warm up and warm up the muscles in advance;
• do not make sudden movements when lifting loads, try to lift weights with a straight back from a squatting position;
• Maintain a balanced, fortified diet.

Conclusion

In conclusion, I would like to note that a sprained back muscle is a serious diagnosis that requires immediate treatment. There are enough means and methods in medicine to completely restore damaged tissues.

Physiotherapy, massage, exercise therapy will help restore the patient’s health as quickly as possible. However, it is important to prevent the development of pathology and observe the necessary preventive measures.

1. Hypothermia.
2. Back injuries.

• Angina pectoris.
• Myocardial infarction.
• Kyphoscoliosis.
• Intercostal neuralgia.
• Spondyloarthrosis.

Back pain in the shoulder blade area

Both older and younger people complain of back pain in the area of ​​the shoulder blades. Pain in the interscapular region does not indicate any particular disease, but is a manifestation of numerous anomalies in the functioning of organs located outside the area of ​​pain concentration.

If your back hurts in the area of ​​the shoulder blades, then the probable cause of the pain may be muscles, nerves, facet joints, ligaments, pathological changes in internal organs, consequences of blows and injuries, etc.

A list of the most significant diseases that cause back pain:

• damage due to trauma components thoracic and cervical spine;
• changes in breast or cervical spine caused by osteochondropathy;
• curvature of the spine in different directions due to developmental anomalies - scoliosis;
• development of kyphosis and kyphoscoliosis due to incorrect posture- stooping, hunching;
• deforming spondyloarthrosis;
• herniated disc in the thoracic vertebrae;
• humeroscapular periarthritis - muscle pain in the shoulder girdle and joint;
• intercostal neuralgia;
• shingles;
• heart disease: ischemia, myocardial infarction;
• damage, diseases and tumors of the mediastinal organs;
• indigestion, duodenal disease;
• dysfunction of the liver and hepatobiliary system;
• pathology of the lungs and pleura;
• kidney failure;
• long-term performance of any activity against the background of systemic diseases.

Nature of pain

In medical practice, a rational description by the patient of his pain above the lower back is of great importance. Pain between the shoulder blades is a symptom of a number of diseases or pathologies; it is possible to find out the cause of its occurrence by accurately describing its nature, its type, and the frequency of its appearance and disappearance. A correct diagnosis will eliminate the burning sensation in the back, pain in the shoulder blades, the causes will be determined with the help of a doctor and diseases will be prevented in the future.

The nature of back pain is:

1. chronic - mild pain is typical, disturbing for a long time, practically never stopping;
2. acute - specific pain, suddenly striking and fading, much stronger than chronic.

When your back hurts in the area of ​​the shoulder blades, the pain is localized in different places. This gives grounds to classify pain in the shoulder blades into three types:

• pain under the shoulder blades (right or left);
• pain between the shoulder blades;
• pain in the shoulder blade on the right or left.

Back pain under shoulder blades

The causes of pain may have absolutely nothing to do with the spine. If a person has back pain below the shoulder blades, then based on a number of accompanying signs, without examinations and tests, it can be assumed that he has typical, frequently occurring ailments.

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• Stomach ulcer. Characterized by regular, increasing pain, weakening or disappearing after vomiting. Pain sensations are localized in the epigastrium, but penetrate into the left scapula.
• Psychological problems. Cause barely perceptible or acute sensations of heaviness, congestion in the chest, tingling in the heart area, compression in the chest. There are cases when similar symptoms affect the neck area and spread under the left shoulder blade.

What causes pain under the right shoulder blade

The way a symptom manifests determines its cause.

The list of reasons explaining the pain under the right shoulder blade is extensive. Examples of the most common:

• Dull, incessantly disturbing, incessant pain with right side back pain can be caused by ordinary muscle spasms due to prolonged uncomfortable body posture, or associated with internal organs: kidneys, pancreas, gall bladder. In most cases, pain appears unexpectedly, with a sharp turn of the head, sneezing, coughing.
• Acute, piercing pain, sharp or increasing, localized on the right side of the heart or in the interscapular space may be a consequence of a disease of the internal organs and is not associated with the spine. Many body systems, deviations from normal functioning, cause pain under the right shoulder blade - cardiovascular, excretory, digestive, etc.
• Stringing and cutting pain under the right shoulder blade makes you think about the onset of diseases of the musculoskeletal system: chondrosis, osteochondrosis, spondylosis, etc. Pain of this type can be caused by neuralgia when pinched nerve roots occur. The causes of such pain can be oncological tumors, not often, but such phenomena are present in medical practice.
• The patient has pain in the back muscles under the shoulder blades, then you should think about diseases respiratory system. Pain under the shoulder blades can be caused either by overload of the muscles in this place or the thoracic spine.
• Osteochondrosis of the cervical spine. It most often provokes unilateral aching, dull pain, which is concentrated below the occipital part. Their peculiarity is to appear in the morning, tearing the patient out of sleep. The pain syndrome is especially severe during sharp flexion and extension of the neck. Applying heat to the painful surface (warm bath) relieves pain. Patients react to this pathology by complaining of pain under the shoulder blades, pain spreading to the arm or head.

Causes of pain between the shoulder blades

Intercostal neuralgia is manifested by shooting pain. When you take a deep breath, sharply turn your body, or palpate the inflamed area between the ribs, the pain increases.

Lung diseases are accompanied by pain between the shoulder blades when inhaling, with a deep breath the pain intensifies, a high temperature and cough are noted.

If the pain increases with shallow inspiration, it often radiates under the right shoulder blade, and there may be a diaphragmatic abscess.

When a normal tilt of the head causes pain between the shoulder blades, this is associated with an inflammatory process in the muscles of the interscapular region, as well as damage to their tendons and ligaments.

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Pain between the shoulder blades sometimes occurs when swallowing; its origin is caused by diseases of the esophagus (inflammation or ulcer); inflammatory processes in organs located between the two lungs; diaphragm damage.

Burning between the shoulder blades is caused by attacks of renal and biliary colic, osteochondrosis of the cervical or thoracic vertebrae and reflux esophagitis.

Pain in the shoulder blade on the right and left

The reason is receiving a blow to the shoulder blade or falling on it. An awkward fall on your hand or elbow leads to a fracture of the scapula. The injury causes severe pain, the intensity of the pain increases with the movement of the arms. Swelling forms.

Pterygoid blade. Appears as a result of paralysis of the muscles - trapezius, rhomboid, serratus anterior, or is the result of numerous bruises in the forearm area, damage to the long thoracic nerve.

Scapular crunch is a crunch in the shoulder joint.

Treatment methods

At the beginning of treatment, it is necessary to determine the condition of the lungs and heart. A cardiologist and therapist will most likely prescribe an ECG or ultrasound procedure. After consultation with specialists, we can safely not consider these organs to be the causes of pain between the shoulder blades.

When pain occurs when moving the spine near the shoulder blade, the cause is usually sought in the back. The pain is sometimes so severe that it can be confused with symptoms of panic attacks.

When diagnosing the spine, a regular X-ray is often not enough; a complete picture is provided by an MRI of the thoracic region. At this stage of clarifying the diagnosis, a consultation with a vertebrologist is required.

It is possible to get rid of pain in the area of ​​the right shoulder blade through treatment only when the causes of its occurrence are clarified. If this pain is associated with diseases of the internal organs, it is necessary to treat them. Which doctor will treat depends on the specific organ. The pain under the right shoulder blade will disappear on its own when the affected area is treated internal organ will be successful.

If there is a connection between back pain on the right and in the interscapular region with diseases of the spine, then medical care will be focused on the source of inflammation. To eliminate the inflammatory process, analgesics, chondroprotectors, non-steroidal anti-inflammatory drugs, and corticosteroids are used.

Dull pain that does not go away for a long time, resulting from muscle spasm or neuralgia, is effectively treated with warming ointments with an analgesic effect: Voltaren, Fastum-gel, Diclofenac, Capsicam. Patches are also used that provide a warming and analgesic effect.

Prevention

The back in the area of ​​the shoulder blades will not hurt if a person moves a lot and follows healthy image life. The movements involve uniform loads on the muscles, proper lifting of weights, massage sessions and various types physiotherapy. Exercising is the best preventative measure.

Problems in the area of ​​the subscapularis muscle and how to eliminate them

The subscapularis muscle has a wide and thick triangular shape. It runs along the entire costal surface of the scapula. When it is affected by inflammation, pain and other unpleasant symptoms are noted. Let's take a closer look at the function of the subscapularis muscle, as well as how diseases and pathologies associated with it are treated.

Function of the subscapularis muscle

The subscapular region has fleshy areas. With the help of a flat tendon, it is attached to the lesser tubercle and the crest of the lesser tuberosity of the humerus bone.

The subscapularis muscle allows the shoulder to rotate inward while simultaneously bringing the shoulder toward the body. The muscle is innervated by the subscapular nerve, and the blood supply is by the subscapular artery.

Muscle problems and diagnosis

If inflammation develops or other problems arise in the subscapularis area (for example, tendon rupture, the appearance of serious diseases), the person feels pain in the shoulder. If you have this symptom, you need to examine:

• muscle tissue;
• all muscles;
• upper limbs;
• shoulder area;
• deltoid muscle;
• supraspinatus and infraspinatus muscles;
• other important muscles, according to the doctor.

The examination is carried out using ultrasound of the muscles, as well as palpation. The doctor orders a blood test for the patient to check the levels of lactic acid, lactate dehydrogenase and total creatine kinase in the blood. If necessary, other diagnostic methods are carried out.

Causes of pain under the shoulder blades

The subscapularis muscle may ache due to scapular-costal syndrome, which is provoked by chest abnormalities, muscle hypertonicity, hypothermia, psycho-emotional trauma and stress. Muscle inflammation and pain can affect the area under both the left and right shoulder blades.

There may be pain under the left shoulder blade due to injuries, incorrect position during sleep, acute respiratory infections or flu, shoulder dislocation, fracture, tear of the rotator cuff, compression of nerves, trigger points, subscapular inflammation, diseases of internal organs.

Under the right shoulder blade, pain and inflammation occur due to cholecystitis, myocardial infarction, liver disease, breast cancer, arthritis of the shoulder joint, biomechanical and other reasons.

Development of tendinopathy

With tendinopathy of the subscapularis muscle, degenerative changes occur. Most often they are provoked by insufficient blood supply to the shoulder muscles or hereditary connective tissue pathology.

The pain with this disease becomes stronger when a person scratches his face, eats with a spoon, or moves his arm behind his back.

Tendopathy of the muscle under the shoulder blade can also occur due to persistent tendon injuries.

Appearance of gaps

Often, if not treated properly, tendinopathy leads to rupture of the subscapularis muscle. When a rupture occurs, a sharp pain is felt. The person cannot move his arm independently.

If the tendons in the subscapular region are partially torn, the victim can move his arm. In cases where the tendon is completely ruptured, the patient is unable to even lift the limb.

The affected subscapular area is fixed with a tight bandage or splint. Once the pain goes away and the shoulder gradually returns to its function, it is recommended to perform exercises to develop the joint.

If the tendon is completely ruptured, the doctor performs surgery. Surgical treatment is also carried out if conservative therapy does not bring results.

When do you need a doctor's help?

You should seek medical help for the following symptoms:

• in the presence of deformation, redness, swelling in the shoulder joint or in the place where the subscapular region is located;
• with acute pain syndrome, which is accompanied by impaired breathing, palpitations, lack of air;
• in case of bleeding or fracture of bone tissue;
• for pain that causes dizziness or fainting;
• with impaired breathing.

If at least one of the listed symptoms occurs in a patient with pain and inflammation in the subscapularis muscle, it is important not to hesitate, but to go to the hospital immediately.

Features of therapy

Treatment is prescribed by the doctor, taking into account the causes of pain and inflammation in the subscapular region. If a traumatic cause is excluded, treatment is carried out with medications or other therapies.

The subscapular region should be treated in the following ways:

1. With the help of rest. In some situations, it is enough just to have a good rest so that the muscles can recover and the overstrain in them disappears.
2. Inflammatory processes must be eliminated with non-steroidal anti-inflammatory drugs: for example, Movalis, Voltaren or Celebrex.
3. If the subscapular region is affected by muscle spasm, muscle relaxants are used.
4. Chronic manifestations of pain accompanied by depression are treated with antidepressants.
5. Physiotherapy is also used to reduce inflammation in tissues and muscles, relieve pain and improve regeneration.
6. Manual treatment is used to remove blocks in muscles and improve mobility of motor segments.

Experienced specialists influence biologically active points, as a result of which pain is reduced and normal conduction along nerve fibers is restored.

To remove muscle spasms In the subscapular region, it is recommended to undergo a whole course of massage. Massage actions also help improve blood circulation and overall well-being.

Preventing problems in the subscapularis muscle

Prevention of pain in the area under the shoulder blades is to follow the following recommendations:

1. Sleep on a hard bed with a small pillow.
2. Every day, perform a set of exercises for all muscles, including the area under the shoulder blades.
3. Even if you have slight pain in your back or shoulder, limit the movement of your arm on the side of the pain and be sure to rest.
4. During monotonous, rhythmic work, regularly massage the shoulder area, as well as the entire back. For procedures you can use essential oils, warming and relaxing gels.

Daily muscle exercises should not be too long. In the morning it is enough to exercise for 20 minutes. During the day, it is recommended to do three approaches lasting 15 minutes.

Now you know what the subscapularis muscle is, why pain may occur under the shoulder blades, and what treatment can help get rid of unpleasant symptoms. You cannot self-medicate. Therapy for pathologies in the subscapular region is prescribed only by a doctor and must be strictly observed.

Pain in the muscles of the shoulder blade

Painful sensations in the muscles, myalgia, as a symptomatic phenomenon have not been studied enough, especially pain in the muscles of the scapula. Until now, muscle pain symptoms are classified either as vertebrogenic diseases or neurological diseases, that is, they are associated with radiculopathy, spondyloarthrosis, osteochondrosis, and so on.

Relatively recently, separate nosological units have appeared in the classification of diseases - fibromyalgia and myalgia, which are directly related to muscle tissue. Despite the fact that soft tissue pathologies, including pain in the scapula muscles, have been studied since the 19th century, there is no unity in terminology and systematization of syndromes yet. Obviously, this is due to the close anatomical relationship between soft (periarticular) tissues and bone structures in the back and in the human body in general. Pathology of the back can cover several nearby anatomical zones at once; such pain is usually called dorsalgia, but pain manifestations in the region scapularis (area of ​​the shoulder blades) are more correctly and accurately called scapalgia.

Causes of pain in the muscles of the scapula

Unlike other muscle syndromes, the causes of pain in the scapula muscles most often have nothing to do with the “culprit” of all spinal pain – osteochondrosis. This is due to the lack of mobility and rather strong structure of the thoracic spine. Consequently, almost all painful sensations in the area of ​​the shoulder blades are associated with muscle tissue, as well as damage to tendons and supraspinous ligaments.

The main cause of aching pain in the middle of the back is explained by prolonged muscle tension, usually due to the specifics of professional activity. First of all, this applies to those who maintain the same position for a long time, often sitting - drivers, office workers, seamstresses, students, and so on. As tension accumulates in the shoulders and area of ​​the shoulder blades, it leads to compensatory shortening and contraction of the pectoral muscles, aggravating the condition and the habit of stooping, stretching the head and neck forward. As a result, the levator scapulae muscles, part of the trapezius muscle, sternoclavicular, deltoid muscles are overstrained, and others located in the middle of the back - the lower part of the trapezius, neck flexors, serratus anterior - are subject to compensatory stretching or weakening, all these abnormal, non-physiological phenomena provoke pain.

Also in clinical practice, the causes of pain in the scapula muscles are classified according to the types of muscular-tonic syndromes:

1. Syndrome pectoral muscle(pectoralis minor) or scalene syndrome. Pain in the area of ​​the shoulder blades manifests itself on the line of the 3rd-5th rib and feels like a burning, aching sensation. The symptom may be worse at night, when moving the body, or when abducting the arms (hyperabduction). Often such manifestations resemble angina attacks, which makes diagnosis much more difficult. In addition, chronic hypertonicity of the pectoralis minor muscle leads to infringement of the nerve and choroid plexus, a bundle located near the coracoid scapular process, resulting in loss of sensitivity in the hand and fingers. Pain in pectoral muscle syndrome is localized in the anterior deltoid zone, between the shoulder blades, and is transmitted along the ulnar (ulnar) surface of the shoulder and forearm.
2. Syndrome m. serratus posterior - the superior posterior serratus muscle is often provoked by a degenerative process in the upper thoracic intervertebral discs. The pain is localized under the shoulder blade, felt deep in the muscles, and is an aching, dull pain.
3. Syndrome m. serratus posterior inferior - the lower posterior serratus muscle is felt as a chronic, debilitating dull pain in the lower back (at the level of the chest). The syndrome limits body movements when bending and rotating.
4. Interscapular syndrome is felt as aching, aching pain between the shoulder blades. The symptom intensifies with prolonged horizontal position of the body, when bending, the pain can become quite severe when traveling over rough terrain (vibration). The pain is localized at the attachment point of the rhomboid, trapezoid and latissimus muscle back (scapular spine area), can spread to the shoulder, forearm along the ulnar nerve.
5. Acquired pterygoid scapula syndrome, which causes paralysis of the serratus anterior, trapezius, or rhomboid muscles. Paralysis can be caused by both an infectious disease and injury, bruise, including professional ones (athletes, circus performers).

In addition, pain in the muscles of the scapula can be caused by an inflammatory process in the muscle tissue - myositis. Myositis, in turn, is provoked by the following factors:

1. Hypothermia.
2. Infections, including viral ones.
3. Occupational diseases associated with muscle hypertonicity.
4. Back injuries.

Quite often, pain symptoms in the area of ​​the shoulder blades are poorly differentiated by sensation, so it is difficult to determine what actually hurts - muscles, bone tissue, tendons, or whether this symptom is referred pain, indicating possible pathologies, such as the following:

• IHD – coronary heart disease.
• Angina pectoris.
• Myocardial infarction.
• Protrusion or herniation of intervertebral discs of the thoracic spine.
• Kyphoscoliosis.
• Intercostal neuralgia.
• Spondyloarthrosis.
• PUD – gastric ulcer.
• Diseases of the respiratory system – pneumonia, pleurisy.

In order to correctly determine the causes of pain in the scapula muscles, it is necessary to describe the characteristics of the symptom as accurately as possible.

Diagnosis of pain in the scapula muscles

The task of diagnostic measures in determining the cause muscle pain in the area of ​​the shoulder blades - this is, first of all, the exclusion of possible life-threatening pathologies - angina attack, myocardial infarction, perforation of a stomach ulcer and the following diseases:

• Oncological processes in the spinal column.
• Oncological processes in internal organs.
• Neurological pathologies requiring urgent therapy.
• Psychogenic factors, diseases, including psychopathologies.

This is due to the fact that diagnosing pain in the scapula muscles is difficult due to the nonspecificity of the symptoms; the clinical picture rarely indicates a specific diagnostic direction; in addition, almost all dorsalgia rarely correlates with the results of instrumental examinations. Quite often there are cases when there is a pain symptom, but the examination does not reveal a single reliable pathological source of pain; it also happens that studies identify a pathology that is not accompanied by a clearly expressed clinical sign.

As a rule, diagnosing pain in the scapula muscles includes the following actions:

• A brief history taking, a detailed description of the background history of the symptom is not required, since a painful muscle symptom is not considered pathognomic for a dangerous, threatening pathology.
• Clarification of the nature and parameters of pain:
  • Localization, possible irradiation.
  • In what posture or body position does pain appear?
  • What time of day does the pain occur?
  • Symptom connection with motor activity, other factors.
  • The rate of symptom development is spontaneous or increasing pain.
• Visual examination of the patient:
  • Asymmetry of the glenohumeral zone.
  • Detection of possible scoliosis, abnormalities in the structure of the spine (Forestier symptom test).
  • Mobility of the spinal column in thoracic region(Ott's symptom test, Thomayer's symptom).
  • Determination of possible pain along the spinous processes (Zatsepin’s symptom, Vershchakovsky’s test, bell’s symptom).
• Instrumental examination is most often not required, since muscle pain is considered benign in 95% of cases. Research is needed only in cases of suspicion of the following pathologies:
  • Signs of an acute infectious process.
  • Signs of oncology.
  • Obvious neurological symptoms.
  • Injury.
  • Unsuccessful treatment for a month.
  • X-rays are also necessary if the patient is referred for manual therapy or physiotherapeutic procedures.
• To identify characteristics muscle structure Electromyography may be prescribed.

It should be noted that the widely used practice of sending a patient with muscle pain for an x-ray can significantly complicate the diagnosis, since the vast majority of our contemporaries have certain signs of osteochondrosis and other diseases of the spine. The mere presence of a degenerative process in the spinal column does not exclude the myogenic factor that provokes pain in the muscles of the scapula and cannot be the basis for a correct diagnosis.

How to prevent shoulder blade muscle pain?

How to prevent muscle pain, wherever it develops, in the back, in the area of ​​the shoulder blades, lower back, neck? Obviously, there are no specific recommendations, because each human body is individual in its anatomical structure, physiological and other parameters. However, preventing pain in the scapula muscles means following well-known, but, unfortunately, rarely used measures in practice. These rules relate primarily to the following points:

1. If a person is undergoing treatment for muscle or other pain or disease, it is necessary to strictly observe and fulfill all medical prescriptions. Self-medication is an extremely common phenomenon, but its effectiveness is minimal, in contrast to the huge number of complications.
2. After completing a course of treatment for muscle pain, you need to maintain a gentle motor regimen, but this does not mean complete rest and inaction. Muscles need to be trained, otherwise the opposite effect of hypertonicity will occur - adynamia, atrophy and weakness of the muscle structure.
3. Muscle tone is well maintained regular classes sports, even if a person does not engage in professional sports, a simple morning exercises may well replace complex training.
4. All factors provoking static voltage should be excluded. If a person’s professional activity is associated with constant overstrain of the muscles of the shoulder blades, it is necessary to regularly change body position during the working day. do warm-ups.
5. To maintain muscle tone and unload the spine, you need to monitor your posture and, if necessary, wear a corrective corset.

Pain in the muscles of the scapula is a rather complex polyetiological symptom, and not an independent disease. Determine the exact cause pain, conduct all necessary examinations for this purpose and prescribe effective treatment Only a doctor can. All that is required of the person experiencing discomfort in the area of ​​the shoulder blades is to take care of their health and promptly seek help at the first warning signs.

Sources:

A dislocation is an injury characterized by displacement articular surfaces relative to each other. Dislocation of the scapula is not a completely correct diagnosis; this is what the injury is mistakenly called humerus in the scapular or acromioclavicular region.

As a result of damage, the scapula and humerus are displaced relative to each other. As a result, the motor function of the affected joint is impaired, in some cases the limb is completely immobilized.

The injury occurs as a result of a strong pull on the arm or a fall on the upper limb. Immediately after the injury, it is important to provide first aid to the victim and hospitalize him. Timely treatment will help avoid dangerous complications.

Common causes of scapula dislocation

To better understand the nature of the injury, it is necessary to delve into the anatomy. The scapula is a flat triangular bone that connects to the clavicular region using the scapular or acromial process. This is how it is formed shoulder girdle and scapuloclavicular joint. With the help of another joint, the scapula is attached to the head of the humerus, thus forming the shoulder joint.

A dislocated shoulder blade occurs as a result of a sharp and strong pull on the arm or a blow to the shoulder blade. The scapula shifts sideways, and its lower corner is pinched by the ribs. In some cases, damage to the muscles that fix the scapula may occur.

Dislocation of the acromioclavicular joint is often diagnosed. This injury occurs due to a fall on the shoulder or a blow to the collarbone area. It is connected to the scapula by the coracoid and acromioclavicular ligaments. Doctors distinguish the following types of dislocation depending on the nature of the rupture:

• Incomplete - one ligament ruptures;
• Complete – characterized by rupture of both ligaments;
• Supracromial - the clavicle is displaced above the acromial process;
• Subacromial - the outer end of the clavicle is located under the acromion. This type of injury is the rarest.

The shoulder is injured as a result of a fall on a forward or extended upper limb. Displacement of the joints of the shoulder and scapula relative to each other occurs as a result of falling backward onto an abducted limb. The displacement of the shoulder joint in relation to the scapular cavity can be lower, posterior or anterior.

Symptoms and types of scapula dislocation

Dislocation of the scapula is divided depending on the severity and time elapsed since the injury. If the injury occurred less than 3 days ago, then it is fresh, about 20 days - stale, and from 21 days - old.

Dislocation of the scapula depending on the severity:

• I degree – injury in which the collarbone does not displace;
• II degree - incomplete dislocation of the clavicle, which is characterized by rupture of the acromioclavicular ligaments, while the coracoid ligaments remain unharmed. If the dislocation occurred more than 14 days ago, then degenerative changes in the upper limb girdle appear (grade B). If the injury appeared before 14 days and there are no degenerative changes, then this is grade A;
• Grade III is a dislocation of the clavicular region, in which the acromioclavicular and coracoclavicular ligaments are torn. Grades A and B, as in the previous paragraph, depend on the timing of the injury and the presence or absence of degenerative changes;
• VI degree – the clavicle moves posteriorly;
• V degree – the collarbone moves upward.

If the scapula is injured, the victim cannot make active movements of the limb, and pain is felt with passive movements. If you touch the damaged area, the pain intensifies. Upon visual examination, asymmetry of the shoulder blades is observed, the axillary edge and the lower part of one of them protrude.

In addition, the doctor cannot feel the lower edge of the scapula because it is pinched by the ribs. The vertebral side may deviate backward even after the scapula has been reduced. Visually, one limb is slightly longer than the other, and the forearm is shortened. After a day or two, a bruise appears in the area of ​​the dislocation, and this is how a complete dislocation with rupture of the clavicular-coracoid ligaments appears.

This
healthy
know! First aid for a dislocated scapula

If symptoms of a dislocated scapula occur, it is necessary to provide assistance to the person:

1. Call an ambulance, place the victim on a backboard on his stomach;
2. Swelling and bruising occur in the damaged area due to rupture of blood vessels. To do this, apply a cold compress to the area of ​​dislocation.
3. If the pain is very severe, you can take an analgesic.
4. It is important to immobilize the injured limb. Failure to do so may cause severe pain or worsen the misalignment of the joint parts. For this purpose, use a tire made from any available material.
5. The victim is transported to the emergency room.

Signs of a sprain are often confused with symptoms of other more serious injuries.. For this reason, before reducing the displacement, an X-ray examination is performed.

Self-resetting the bone after a dislocated scapula can only aggravate the situation.

Treatment and methods of reduction

Once the diagnosis of scapula dislocation has been established, therapy can begin. The injury is treated conservatively or surgically.

In case of subluxation of the acromioclavicular joint, the damaged limb is placed in a scarf. To relieve pain, a solution of novocaine is injected. After 2–3 days, when the pain subsides, physical therapy with shoulder abduction up to 90°. This procedure is performed within 7 days.

In case of complete dislocation, all ligaments must be firmly fixed for 6–8 weeks. They will recover only after long-term treatment, and therefore the victim is hospitalized.

In case of irreducible dislocation (soft tissue gets into the space between the surfaces of the articulation), arthrotomy is prescribed. During the operation, the shoulder joint is exposed, the surgeon removes the obstruction and reduces the dislocation.

Regardless of the method of reduction, a plaster splint is applied to the injured limb. The duration of wearing it depends on the age of the patient, for example, young people wear it for about 30 days, and older people - 20 days. Although for older patients they usually use a soft scarf rather than a plaster cast.

In addition, ultra-high frequency therapy is used to treat dislocation. The patient can also take analgesics and calcium supplements prescribed by the doctor.

While wearing a splint, the patient must perform special exercises, move the fingers and hand of the injured arm, clench and unclench his fist. This way, swelling will disappear faster and it will be possible to prevent muscle atrophy.

After reduction, a cold compress should be applied to the damaged area.

Rehabilitation after injury

After the bandage is removed, the recovery process begins. Rehabilitation includes procedures such as magnetic therapy and physical therapy. It is important to consult a doctor regarding behavior during the recovery period. At first, you should avoid lifting weights (carrying heavy bags, lifting heavy objects, doing push-ups, etc.).

If you notice that after removing the plaster cast, the shoulder blade does not accept correct position, then there is no need to panic. It goes into place 4 to 5 weeks after the injury.

If after this time the bone is in the wrong position, then you need to consult a doctor. In this case, surgery may be necessary. The operation is necessary to fix the angle of the scapula near the ribs and spine.

Complications and consequences

Untimely or incorrect treatment of a dislocated scapula can lead to dangerous complications. If a subluxation is not treated, it will eventually transform into a complete dislocation, which damages tendons, ligaments, blood vessels and nerves.

As a result, the sensitivity of the affected hand decreases and the motor function of the joint is impaired. In addition, such an injury risks rupture of the capsule, fracture of the humeral head, damage to the periosteum, or constant spontaneous repetition of the dislocation.

To avoid re-injury, you need to systematically perform special exercises, even after rehabilitation. If the patient is engaged active species sports, then it must provide reliable protection to the joints with the help of knee pads, elbow pads, etc.

Thus, a dislocated scapula is a serious injury that can lead to dangerous complications. If symptoms occur that indicate displacement of the articular surfaces, the victim must be given first aid and sent to the emergency room. The patient must follow all the doctor's instructions regarding the restoration of the damaged joint. Only in this case can serious consequences be avoided.