Interscapular pain

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

Interscapular pain is pain localized in the interscapular area between the shoulder blades. The most common causes of interscapular pain are due to secondary disease conditons. Primary causes of interscapular pain are rare.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular	Acute myocardial infarction, aneurysm of sinus of valsalva, aortic dissection, aortic hammer syndrome, dissecting aortic aneurysm, dissecting intramural hematoma of the esophagus (DIHE), pulmonary embolism, ruptured aortic aneurysm
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Necrotizing fasciitis
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Dissecting intramural hematoma of the esophagus (DIHE)
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Chikungunya, Guillain-Barre syndrome, necrotizing fasciitis, posterior mediastinal abscess, spinal epidural abscess
Musculoskeletal/Orthopedic	Acromioclavicular joint disclocation, dislocated shoulder, rotator cuff tear, shoulder instability, spinal disc herniation, spondylolisthesis
Neurologic	Cervical disc disease, cervical radiculopathy, chronic fatigue syndrome, disc prolapse, dorsal scapular nerve entrapment, Guillain-Barre syndrome, spinal cord infarction, spinal cord injury, spinal disc herniation, spinal epidural abscess, spinal epidural hematoma, spontaneous intracranial hypotension, temporal arteritis
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	Temporal arteritis
Overdose/Toxicity	No underlying causes
Psychiatric	Chronic fatigue syndrome
Pulmonary	No underlying causes
Renal/Electrolyte	Autosomal dominant polycystic kidney disease
Rheumatology/Immunology/Allergy	Ankylosing spondylitis, chronic fatigue syndrome, fibromyalgia, Guillain-Barre syndrome, necrotizing fasciitis, polymyalgia rheumatica, spondylolisthesis, temporal arteritis
Sexual	No underlying causes
Trauma	Trauma, whiplash injury
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Acromioclavicular joint disclocation
Acute myocardial infarction
Aneurysm of sinus of valsalva^[3]
Ankylosing spondylitis
Aortic dissection
Aortic hammer syndrome^[4]
Autosomal dominant polycystic kidney disease^[5]
Cervical disc disease
Cervical radiculopathy^[6]
Chikungunya
Chronic fatigue syndrome
Disc prolapse
Dislocated shoulder^[7]
Dissecting aortic aneurysm^[8]
Dissecting intramural hematoma of the esophagus (DIHE)^[9]
Dorsal scapular nerve entrapment^[10]
Fibromyalgia
Guillain-Barre syndrome^[11]

Necrotizing fasciitis^[12]
Polymyalgia rheumatica
Posterior mediastinal abscess^[13]
Pulmonary embolism
Rotator cuff tear
Ruptured aortic aneurysm^[14]
Shoulder instability
Spinal cord infarction^[15]
Spinal cord injury^[16]
Spinal disc herniation
Spinal epidural abscess^[17]
Spinal epidural hematoma^[18]^[19]
Spondylolisthesis^[20]
Spontaneous intracranial hypotension^[21]^[22]
Temporal arteritis
Trauma
Whiplash injury^[23]^[24]

References

↑ Somasamudra P, Smith E, Tandan R (2011). "Aortic dissection presenting as pleural effusion". BMJ Case Rep. 2011. doi:10.1136/bcr.03.2011.3956. PMC 3118903. PMID 22692486.
↑ Zanobetti M, Bigiarini S, Coppa A, Conti A, Innocenti F, Pini R (2012). "Usefulness of chest ultrasonography in detecting pulmonary embolism in patient with chronic obstructive pulmonary disease and chronic renal failure: a case report". Am J Emerg Med. 30 (8): 1665.e1–3. doi:10.1016/j.ajem.2011.09.021. PMID 22154162.
↑ Lescan M, Walker T, Kobba J, Schneider W, Schlensak C (2014). "The preoperative management of a patient with a large aneurysm of the sinus of valsalva and takotsubo cardiomyopathy". Gen Thorac Cardiovasc Surg. 62 (1): 64–7. doi:10.1007/s11748-013-0212-x. PMID 23378016.
↑ Komen N, Vercauteren S, de Roover D (2011). "Aortic hammer syndrome". J Endovasc Ther. 18 (4): 497–500. doi:10.1583/11-3475.1. PMID 21861736.
↑ Rodrigues L, Neves M, Machado S, Sá H, Macário F, Alves R; et al. (2012). "Uncommon cause of chest pain in a renal transplantation patient with autosomal dominant polycystic kidney disease: a case report". Transplant Proc. 44 (8): 2507–9. doi:10.1016/j.transproceed.2012.07.014. PMID 23026633.
↑ Tanaka Y, Kokubun S, Sato T, Ozawa H (2006). "Cervical roots as origin of pain in the neck or scapular regions". Spine (Phila Pa 1976). 31 (17): E568–73. doi:10.1097/01.brs.0000229261.02816.48. PMID 16924193.
↑ Barbier O, Van Gaver E, Rigal S (2010). "[A bilateral posterior shoulder dislocation caused by humeral head osteonecrosis]". Chir Main. 29 (1): 48–51. doi:10.1016/j.main.2009.11.008. PMID 20093062.
↑ Fukushima K, Kamisawa O, Yamaguchi T, Misawa Y, Kato M, Hasegawa T (1992). "[Dissecting aortic aneurysm involving an aberrant right subclavian artery]". Nihon Kyobu Geka Gakkai Zasshi. 40 (2): 278–81. PMID 1593169.
↑ Pomara C, Bello S, D'Errico S, Greco M, Fineschi V (2013). "Sudden death due to a dissecting intramural hematoma of the esophagus (DIHE) in a woman with severe neurofibromatosis-related scoliosis". Forensic Sci Int. 228 (1–3): e71–5. doi:10.1016/j.forsciint.2013.02.005. PMID 23453641.
↑ Sultan HE, Younis El-Tantawi GA (2013). "Role of dorsal scapular nerve entrapment in unilateral interscapular pain". Arch Phys Med Rehabil. 94 (6): 1118–25. doi:10.1016/j.apmr.2012.11.040. PMID 23220342.
↑ Ruts L, van Koningsveld R, Jacobs BC, van Doorn PA (2007). "Determination of pain and response to methylprednisolone in Guillain-Barré syndrome". J Neurol. 254 (10): 1318–22. doi:10.1007/s00415-006-0515-2. PMC 2778673. PMID 17426908.
↑ Rostgaard-Knudsen M, Holst-Hansen C, Schønheyder HC (2011). "[Necrotising fasciitis in a patient infected by Streptococcus pneumoniae]". Ugeskr Laeger. 173 (24): 1732–4. PMID 21696680.
↑ Ahmad R, Ishlah W, Shaharudin MH, Sathananthar KS, Norie A (2008). "Posterior mediastinal abscess secondary to esophageal perforation following fish bone ingestion". Med J Malaysia. 63 (2): 162–3. PMID 18942310.
↑ Mitkowski P, Trojnarska O, Grajek S, Pawlak B, Pyda M, Brocki Z; et al. (1995). "[Unusual clinical course of ruptured aortic aneurysms--reports of three cases]". Pol Arch Med Wewn. 93 (2): 171–8. PMID 7479237.
↑ Toro G, Roman GC, Navarro-Roman L, Cantillo J, Serrano B, Vergara I (1994). "Natural history of spinal cord infarction caused by nucleus pulposus embolism". Spine (Phila Pa 1976). 19 (3): 360–6. PMID 8171373.
↑ Frisbie JH (2009). "Thyrotoxic cardiomyopathy and encephalopathy in a paraplegic man". Spinal Cord. 47 (3): 262–3. doi:10.1038/sc.2008.46. PMID 18475276.
↑ Nejat F, Ardakani SB, Khotaei GT, Roodsari NN (2002). "Spinal epidural abscess in a neonate". Pediatr Infect Dis J. 21 (8): 797–8. PMID 12233718.
↑ Dimou J, Jithoo R, Bush S (2010). "A patient with delayed traumatic cervical spinal epidural haematoma presenting with hemiparesis". J Clin Neurosci. 17 (3): 404–5. doi:10.1016/j.jocn.2009.02.030. PMID 20074959.
↑ Ozdemir O, Calisaneller T, Yildirim E, Caner H, Altinors N (2008). "Acute spontaneous spinal subdural hematoma in a patient with bilateral incarcerated inguinal hernia". Joint Bone Spine. 75 (3): 345–7. doi:10.1016/j.jbspin.2007.05.019. PMID 18337142.
↑ Göz M, Torun MF, Mordeniz C, Aydın MS, Demirkol AH, Karabağ H (2011). "Spondylolisthesis mimicking the progression of dissection in a case of chronic Stanford type B aortic dissection". Ulus Travma Acil Cerrahi Derg. 17 (5): 458–60. PMID 22090335.
↑ Kranz PG, Gray L, Taylor JN (2011). "CT-guided epidural blood patching of directly observed or potential leak sites for the targeted treatment of spontaneous intracranial hypotension". AJNR Am J Neuroradiol. 32 (5): 832–8. doi:10.3174/ajnr.A2384. PMID 21349964.
↑ Albayram S, Asik M, Hasiloglu ZI, Dikici AS, Erdemli HE, Altintas A (2011). "Pathological contrast enhancement of the oculomotor and trigeminal nerves caused by intracranial hypotension syndrome". Headache. 51 (5): 804–8. doi:10.1111/j.1526-4610.2010.01825.x. PMID 21521210.
↑ Maimaris C, Barnes MR, Allen MJ (1988). "'Whiplash injuries' of the neck: a retrospective study". Injury. 19 (6): 393–6. PMID 3267643.
↑ Evans RW (1992). "Some observations on whiplash injuries". Neurol Clin. 10 (4): 975–97. PMID 1435666.

Template:WH Template:WS

[pmid22692486-1] Somasamudra P, Smith E, Tandan R (2011). "Aortic dissection presenting as pleural effusion". BMJ Case Rep. 2011. doi:10.1136/bcr.03.2011.3956. PMC 3118903. PMID 22692486.

[pmid22154162-2] Zanobetti M, Bigiarini S, Coppa A, Conti A, Innocenti F, Pini R (2012). "Usefulness of chest ultrasonography in detecting pulmonary embolism in patient with chronic obstructive pulmonary disease and chronic renal failure: a case report". Am J Emerg Med. 30 (8): 1665.e1–3. doi:10.1016/j.ajem.2011.09.021. PMID 22154162.

[pmid23378016-3] Lescan M, Walker T, Kobba J, Schneider W, Schlensak C (2014). "The preoperative management of a patient with a large aneurysm of the sinus of valsalva and takotsubo cardiomyopathy". Gen Thorac Cardiovasc Surg. 62 (1): 64–7. doi:10.1007/s11748-013-0212-x. PMID 23378016.

[pmid21861736-4] Komen N, Vercauteren S, de Roover D (2011). "Aortic hammer syndrome". J Endovasc Ther. 18 (4): 497–500. doi:10.1583/11-3475.1. PMID 21861736.

[pmid23026633-5] Rodrigues L, Neves M, Machado S, Sá H, Macário F, Alves R; et al. (2012). "Uncommon cause of chest pain in a renal transplantation patient with autosomal dominant polycystic kidney disease: a case report". Transplant Proc. 44 (8): 2507–9. doi:10.1016/j.transproceed.2012.07.014. PMID 23026633.

[pmid16924193-6] Tanaka Y, Kokubun S, Sato T, Ozawa H (2006). "Cervical roots as origin of pain in the neck or scapular regions". Spine (Phila Pa 1976). 31 (17): E568–73. doi:10.1097/01.brs.0000229261.02816.48. PMID 16924193.

[pmid20093062-7] Barbier O, Van Gaver E, Rigal S (2010). "[A bilateral posterior shoulder dislocation caused by humeral head osteonecrosis]". Chir Main. 29 (1): 48–51. doi:10.1016/j.main.2009.11.008. PMID 20093062.

[pmid1593169-8] Fukushima K, Kamisawa O, Yamaguchi T, Misawa Y, Kato M, Hasegawa T (1992). "[Dissecting aortic aneurysm involving an aberrant right subclavian artery]". Nihon Kyobu Geka Gakkai Zasshi. 40 (2): 278–81. PMID 1593169.

[pmid23453641-9] Pomara C, Bello S, D'Errico S, Greco M, Fineschi V (2013). "Sudden death due to a dissecting intramural hematoma of the esophagus (DIHE) in a woman with severe neurofibromatosis-related scoliosis". Forensic Sci Int. 228 (1–3): e71–5. doi:10.1016/j.forsciint.2013.02.005. PMID 23453641.

[pmid23220342-10] Sultan HE, Younis El-Tantawi GA (2013). "Role of dorsal scapular nerve entrapment in unilateral interscapular pain". Arch Phys Med Rehabil. 94 (6): 1118–25. doi:10.1016/j.apmr.2012.11.040. PMID 23220342.

[pmid17426908-11] Ruts L, van Koningsveld R, Jacobs BC, van Doorn PA (2007). "Determination of pain and response to methylprednisolone in Guillain-Barré syndrome". J Neurol. 254 (10): 1318–22. doi:10.1007/s00415-006-0515-2. PMC 2778673. PMID 17426908.

[pmid21696680-12] Rostgaard-Knudsen M, Holst-Hansen C, Schønheyder HC (2011). "[Necrotising fasciitis in a patient infected by Streptococcus pneumoniae]". Ugeskr Laeger. 173 (24): 1732–4. PMID 21696680.

[pmid18942310-13] Ahmad R, Ishlah W, Shaharudin MH, Sathananthar KS, Norie A (2008). "Posterior mediastinal abscess secondary to esophageal perforation following fish bone ingestion". Med J Malaysia. 63 (2): 162–3. PMID 18942310.

[pmid7479237-14] Mitkowski P, Trojnarska O, Grajek S, Pawlak B, Pyda M, Brocki Z; et al. (1995). "[Unusual clinical course of ruptured aortic aneurysms--reports of three cases]". Pol Arch Med Wewn. 93 (2): 171–8. PMID 7479237.

[pmid8171373-15] Toro G, Roman GC, Navarro-Roman L, Cantillo J, Serrano B, Vergara I (1994). "Natural history of spinal cord infarction caused by nucleus pulposus embolism". Spine (Phila Pa 1976). 19 (3): 360–6. PMID 8171373.

[pmid18475276-16] Frisbie JH (2009). "Thyrotoxic cardiomyopathy and encephalopathy in a paraplegic man". Spinal Cord. 47 (3): 262–3. doi:10.1038/sc.2008.46. PMID 18475276.

[pmid12233718-17] Nejat F, Ardakani SB, Khotaei GT, Roodsari NN (2002). "Spinal epidural abscess in a neonate". Pediatr Infect Dis J. 21 (8): 797–8. PMID 12233718.

[pmid20074959-18] Dimou J, Jithoo R, Bush S (2010). "A patient with delayed traumatic cervical spinal epidural haematoma presenting with hemiparesis". J Clin Neurosci. 17 (3): 404–5. doi:10.1016/j.jocn.2009.02.030. PMID 20074959.

[pmid18337142-19] Ozdemir O, Calisaneller T, Yildirim E, Caner H, Altinors N (2008). "Acute spontaneous spinal subdural hematoma in a patient with bilateral incarcerated inguinal hernia". Joint Bone Spine. 75 (3): 345–7. doi:10.1016/j.jbspin.2007.05.019. PMID 18337142.

[pmid22090335-20] Göz M, Torun MF, Mordeniz C, Aydın MS, Demirkol AH, Karabağ H (2011). "Spondylolisthesis mimicking the progression of dissection in a case of chronic Stanford type B aortic dissection". Ulus Travma Acil Cerrahi Derg. 17 (5): 458–60. PMID 22090335.

[pmid21349964-21] Kranz PG, Gray L, Taylor JN (2011). "CT-guided epidural blood patching of directly observed or potential leak sites for the targeted treatment of spontaneous intracranial hypotension". AJNR Am J Neuroradiol. 32 (5): 832–8. doi:10.3174/ajnr.A2384. PMID 21349964.

[pmid21521210-22] Albayram S, Asik M, Hasiloglu ZI, Dikici AS, Erdemli HE, Altintas A (2011). "Pathological contrast enhancement of the oculomotor and trigeminal nerves caused by intracranial hypotension syndrome". Headache. 51 (5): 804–8. doi:10.1111/j.1526-4610.2010.01825.x. PMID 21521210.

[pmid3267643-23] Maimaris C, Barnes MR, Allen MJ (1988). "'Whiplash injuries' of the neck: a retrospective study". Injury. 19 (6): 393–6. PMID 3267643.

[pmid1435666-24] Evans RW (1992). "Some observations on whiplash injuries". Neurol Clin. 10 (4): 975–97. PMID 1435666.

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