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Ankylosing spondylitis upper back: Ankylosing spondylitis – Symptoms and causes


9 Facts About Ankylosing Spondylitis, a Surprising Cause of Back Pain

Back pain is very common, and it can be caused by everything from heavy lifting to muscle strain. But one lesser known cause of back pain that you might not be aware of is a chronic condition called ankylosing spondylitis, or AS.

Although the name may sound complicated, ankylosing spondylitis (pronounced an-kih-LOH’-sihng spahn-dih-LY’-tihs), is essentially a type of arthritis that primarily affects the spine, but it can move to other joints. It affects about 1 percent of the U.S. adult population; that’s about the same percentage of people who are affected by rheumatoid arthritis, although AS is far less well known.

In ankylosing spondylitis, inflammation causes chronic pain and stiffness, and the severity can vary from person to person. There’s no cure for AS, but certain healthy lifestyle tactics can help make living with ankylosing spondylitis easier.

9 Surprising Facts About Ankylosing Spondylitis

1.  Ankylosing spondylitis tends to strike at a young age. Unlike other forms of arthritis, AS often appears between ages 17 and 45, according to the Spondylitis Association of America. The peak age of onset is 20 to 30 years old, according to a review published in the journal Anaesthesia. However, children as well as adults over 45 can also be affected.

2. Back pain is not the only symptom. The most common early symptoms of AS are frequent pain and stiffness in the lower back and buttocks that comes on over the course of a few weeks or months. At first, you may experience discomfort on one side, or alternate sides, but ultimately, you’ll typically feel pain on both sides, usually lasting for at least three months. But back pain is not the only sign of ankylosing spondylitis. Besides affecting the spine, AS can also cause problems in the joints of the hips, shoulder blades, ribs, heels, thighs, hands, feet, and neck.

3. Joints aren’t the only body parts affected by ankylosing spondylitis.  “Besides the joints, manifestations of ankylosing spondylitis may include the eyes — with uveitis, which presents as acute eye pain, blurred vision, and sensitivity to light,” says Elyse Rubenstein, MD, a rheumatologist at Providence Saint John’s Health Center in Santa Monica, California. It can also affect the cardiovascular system and is associated with aortic regurgitation, she says, in which blood in the heart flows in the reverse direction. Also, the pulmonary system can be at risk for developing lung abnormalities.

4. Men are at greater risk for ankylosing spondylitis. The condition occurs 2 times as often in men than it does in women, according to the Johns Hopkins Arthritis Center. Other risk factors include having the HLA-B27 genetic marker (a gene found in 90 to 95 percent of people with ankylosing spondylitis), having a family history of AS, and experiencing frequent gastrointestinal infections.

5. Ankylosing spondylitis can be to blame for a “hunchback” appearance.  “When ankylosing spondylitis affects the upper part of the neck, it can create significant kyphosis — the medical term for a hunched back — and cause the head to collapse forward, resulting in a chin-on-chest deformity,” says Neel Anand, MD, medical director of spine trauma surgery at the Cedars-Sinai Spine Center in Los Angeles. “People with kyphosis are unable to look straight, as their neck is stiffened in a downward gaze position.”

6. Smoking worsens ankylosing spondylitis. Although smoking isn’t healthy for anyone, it’s especially important not to smoke if you have ankylosing spondylitis. According to a study published in June 2013 in the journal Expert Review of Clinical Immunology, smoking can lead to more severe AS, less function, and lower quality of life, in addition to negatively affecting the lungs and heart.

7. Ankylosing spondylitis can cause the spine to fuse. “Ankylosing spondylitis, as the name suggests, fuses (ankyloses) the spine (spondyl),” Dr. Anand says. “The ligaments surrounding the spine become bony tissue, and the term ‘bamboo spine’ is commonly used, as the spine becomes one long and rigid bone.”

8. Ankylosing spondylitis may be linked to inflammatory bowel disease (IBD). About 2 to 3 percent of people with IBD also have ankylosing spondylitis, according to the Crohn’s & Colitis Foundation. IBD is a term for certain conditions that involve chronic inflammation of the gastrointestinal tract, including Crohn’s disease and ulcerative colitis. In people with the genetic marker for AS, ankylosing spondylitis sometimes develops after urinary or bowel infections. Having ankylosing spondylitis may also foreshadow the development of an IBD.

9. Rest might not be best for ankylosing spondylitis. Discomfort caused by ankylosing spondylitis is typically worse after resting. Back pain from AS is generally better after exercising or taking a hot bath or shower.

If you have persistent back pain that doesn’t respond to self-help strategies, see your doctor for a thorough examination and the proper evaluation needed to diagnose ankylosing spondylitis.

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Ankylosing spondylitis – Symptoms – NHS

The symptoms of ankylosing spondylitis (AS) usually develop slowly over several months or years. The symptoms may come and go, and improve or get worse, over many years.

AS usually first starts to develop between 18 and 40 years of age.

You may not develop all of the main symptoms of AS if you have the condition.

Back pain and stiffness

Back pain and stiffness are usually the main symptoms of AS. You may find:

  • the pain gets better with exercise, but does not improve or gets worse with rest
  • the pain and stiffness is worse in the morning and at night – you may wake up regularly during the night because of the pain
  • you have pain in the area around your buttocks


As well as causing symptoms in your back and spine, AS can also cause inflammation of the joints (arthritis) in other parts of your body, such as your hips and knees.

The main symptoms associated with arthritis are:

  • pain on moving the affected joint
  • tenderness when the affected joint is examined
  • swelling and warmth in the affected area


Enthesitis is painful inflammation where a bone is joined to a tendon (a tough cord of tissue that connects muscles to bones) or a ligament (a band of tissue that connects bones to bones).

Common sites for enthesitis are:

  • at the top of the shin bone
  • behind the heel (Achilles tendon)
  • under the heel
  • where the ribs join the breast bone

If your ribs are affected, you may experience chest pain and find it difficult to expand your chest when breathing deeply.


Fatigue is a common symptom of AS. It can make you feel tired and lacking in energy.

Other conditions

It’s common for people with AS to also have other conditions, including:

  • iritis, also known as acute anterior uveitis (where the front part of the eye becomes red and swollen)
  • psoriasis
  • inflammatory bowel disease (IBD)

Page last reviewed: 05 January 2023
Next review due: 05 January 2026

Pain in the shoulder blades – causes, diagnosis, consequences and treatment

Pain in the shoulder blades is a sign of various diseases. Often it is associated with a deterioration in general well-being, squeezing the muscles in the affected area, and severe migraines. Sensations signal pathologies of the musculoskeletal system, but may be manifestations of other conditions. With severe recurrent pain, it is worth contacting a specialist to identify the causes. A competent osteopath will help to establish and prescribe therapy.

Sensations in the area of ​​the shoulder blades: aching, pressing, dull on inspiration

The assessment of the type of pain in the shoulder blades allows the diagnosis to be suggested. However, this sign is subjective, and is not the only diagnostic criterion. Allocate:

  • Aching. Usually occurs against the background of protracted pathologies of the musculoskeletal system. It is combined with periods of exacerbation.
  • Pressure. In some cases, squeezing and stiffness worsen in the morning hours, or against the backdrop of recent physical activity.
  • Cutting. Leads to a sharp deterioration in overall well-being. Requires urgent referral to a specialist for diagnosis.
  • Dull pain on inspiration. Usually occurs after traumatic exposure. Sometimes he talks about lung diseases.
  • Burning. Refers to symptomatic manifestations of heart disease. Pain indicates the presence of hernia or protrusion of the spine.
  • Mixed pain. Combines several types of pain described earlier.

Discomfort and pain in the affected area may be exacerbated by movement or walking, or worsened by sneezing and coughing.

If the symptoms do not go away for a long time, it is necessary to urgently visit an osteopath.

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Pain in the shoulder blades and the main factors that provoke sensations

The symptom may indicate diseases of the internal organs or the spine. The main causes of pain in the area of ​​the shoulder blades are:

  • Injuries. Injuries affecting any part of the spine or shoulder girdle cause acute increasing pain manifestations.
  • Incorrect posture. It causes increased pressure on the discs of the spine, leads to incorrect distribution of the load, which ultimately leads to pain.
  • Degenerative processes. Various diagnoses that provoke the gradual destruction of bone and joint tissue lead to pain in the area of ​​​​the shoulder blades. Hernias and protrusions are also degenerative manifestations. The protrusion is not accompanied by damage to the fibrous ring, and the hernia manifests itself as a protrusion of the nucleus pulposus of the disc.
  • Pinched spinal nerves. Sedentary work, intense physical activity or heavy lifting can cause pinching. In the treatment of the condition, as a rule, a neurologist is involved.

Painful spasms in this area may be symptoms of damage to internal organs. It is necessary to exclude pathologies of the heart, respiratory system, pancreas. Sometimes this is a signal of the growth of a malignant tumor or a benign formation with localization in the thoracic region. Diagnosis, because of which the shoulder blades most often hurt, are discussed in more detail below.

The best solution in case of pain is to immediately contact an experienced specialist.

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Degenerative disorder of the spine that occurs due to the combined effect of pathological factors on the musculoskeletal system. It affects the vertebral discs, joints and ligaments that form the spinal column. It develops against the background of overweight, limited motor activity, vibration loads, wearing improperly selected shoes.

The condition leads to muscle spasm, which gradually leads to muscle dysfunction. It is manifested by impaired mobility of the cervical vertebrae, chronic migraine, affects the shoulder blades. In the early stages, the pain syndrome is episodic, aggravated by lifting a load, walking for a long time, and being in a static position. Subsequently, manifestations of pathology are recorded regardless of these factors, radiating to the cervical region and limbs. With a protracted course, osteochondrosis significantly affects the quality of life of the patient, causes chronic mixed pain, convulsions of the triceps muscle.


Shoulder pain causes sciatica or radiculopathy. This is a disease in which the intervertebral discs become less elastic and mobile. The distance between the discs of the spine is reduced, which leads to pinching of the nerve fibers.

As a result, a clinical picture of damage to the roots of the spinal cord is detected, namely:

  • pain under the neck;
  • discomfort in the lumbosacral region and buttocks;
  • spread of acute pain syndrome in the area of ​​the thigh, lower leg, feet;
  • discomfort in the back of the head, tension in the chest and neck.

Against the background of the disease, it is more difficult for the patient to make sudden movements. Physical activity leads to a deterioration in well-being, it becomes difficult to be in a horizontal position. During sleep, the patient bends the leg at the knee to relieve some of the discomfort. Radiculitis develops due to osteochondrosis, against the background of ankylosing spondylitis or an infectious lesion. Manifestations are found in influenza, syphilis, tick-borne encephalitis. Pathology requires complex treatment aimed at stopping the causes of the diagnosis and relieving the pain syndrome. The latter is possible when undergoing therapy with an osteopath.

Neuralgia in the thoracic region

The following symptoms are found in neuralgia:

  • burning, sharp, dull or aching pain, localized in the chest area;
  • involuntary twitching of back muscles;
  • excessive sweating;
  • pale skin.

Pain in neuralgia appears abruptly and grows rapidly. Often, pathology is confused with acute lesions of the heart, for example, myocardial infarction. The key difference between intercostal neuralgia is a clear localization of pain. The patient can always show the point where the sensations are concentrated. In case of heart muscle disease, burning or pain spreads throughout the sternum. The condition worsens with coughing, sneezing, physical activity.

The factors that cause the development of pathology are quite extensive. They include damage to the intervertebral discs and compression of the nerve roots, hypothermia and stress. Neuralgia debuts with excessive stress, the course of a cold. It is closely associated with metabolic disorders and chest trauma.

Periarthrosis of the shoulder blade and adhesive capsulitis

This is a group of diseases caused by damage to the shoulder joint. With humeroscapular periarthrosis, there is pain in the forearms, a decrease in mobility in this area.

The main causes are:

  • injuries and their consequences;
  • dislocations of the shoulder joint;
  • damage to the ligamentous apparatus;
  • infection.

Without proper treatment, the disease progresses rather quickly. After 3-4 months, a serious complication appears – adhesive capsulitis. This is an overgrowth of connective tissue in the area of ​​the joint, leading to gross cicatricial changes and loss of mobility.

Congenital or acquired scoliosis

Scoliosis can occur after a traumatic impact, develop due to improper load distribution, or have a congenital form. This is a curvature of the spine, detected in three planes at once.

Symptoms accompanying the disease:

  • appearance of one, two or three arcs of curvature;
  • asymmetrical rib arrangement;
  • pain between the shoulder blades, in the lumbar region.

A muscle ridge may be found on one side of the body at the back. Scoliosis often manifests itself in adolescence due to rapid growth. Also, the development of the disease is associated with pregnancy. Due to increased loads, the woman’s spinal column is bent, her back hurts a lot, muscle spasms are recorded.

Bechterew’s disease or ankylosing spondylitis

Chronic disease leading to gradual fusion of the intervertebral discs. This pathology is accompanied by loss of mobility in the lumbar region, back pain, changes in posture. Most often, Bechterew’s disease is of a genetic nature, but other causes are likely. It is transmitted predominantly through the male line and debuts at the age of 25-30 years.

In addition to pain in the shoulder blades, chest, and lower back, the patient may complain of general deterioration, damage to the visual apparatus, stiffness of the joints. Diagnosis requires ongoing supportive care. Regular visits to an osteopath and massage courses restrain adhesion, restore mobility to the spine, stop pain and other symptomatic manifestations of the disease.

Diagnosis of pain in the shoulder blades: ultrasound, MRI, CT and X-ray

If acute or chronic pain is detected, an appointment with a specialist is necessary. The following research methods can be recommended for diagnosis:

  • Ultrasound. It is aimed at eliminating violations of the operation of internal systems. It is recommended to conduct a study of the heart muscle, abdominal cavity. In some cases, an ultrasound examination of the vessels of the neck is indicated.
  • Magnetic resonance imaging. An informative technique that allows you to establish why there was pain in the area of ​​​​the shoulder blades. MRI is aimed at visualizing tissues and blood vessels. It allows you to detect deformation of bone and articular tissue. The study reveals the inflammatory process, organ damage and other causes that provoke pain. To increase the information content, a contrast agent is used. It is required to visualize the meninges, blood vessels, tumors.
  • Computed tomography. If it hurts in the shoulder blades, then CT will help find abnormalities in hard and soft tissues. This is a non-invasive and completely safe method for diagnosing a disease.
  • X-ray of the scapular region. Determines factors leading to pain in the shoulder blades, such as scoliosis, Bechterew’s disease. Detects injuries: dislocations, displacements, cracks.

Pain in the shoulder blade may cause a complete examination of the body. Additionally, laboratory tests and a visit to narrow specialists are prescribed.

Consultation of our specialists will help to make the correct diagnosis.

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Treatment of pain in the back and scapula: methods and features

Therapy is determined by the doctor after diagnosis and anamnesis. Diseases of the musculoskeletal system that cause pain in the shoulder blades and in the back area suggest the following therapeutic measures:

  • a course of non-steroidal anti-inflammatory drugs and analgesics to relieve pain;
  • treatment of pain in the shoulder blades through physiotherapy;
  • visiting a masseur and osteopath for shoulder blade problems.

In case of chronic diseases, the patient may be shown a spa treatment. Pain in the upper back and shoulder blades is removed by mud therapy, paraffin compresses, baths with mineral water.

Which doctor will help with problems with the scapula

The patient should contact narrow specialists. Treatment can prescribe:

  • Traumatologist, if discomfort occurs after damage to bone, articular or soft tissues;
  • Neurologist, if there is pain between the shoulder blades due to compression of the nerve roots;
  • Rheumatologist, for the treatment of disorders with pain associated with an inflammatory joint process.

If it hurts in the area of ​​the shoulder blades, then you need to see a cardiologist. It will eliminate possible damage to the heart muscle. Sometimes you need a consultation with a pulmonologist or a gastroenterologist in order to exclude diseases of the lungs and gastrointestinal tract, respectively.

Treatment of the cause of the disease and relief of pain by an osteopath

An osteopath is recommended for relief of pain in the shoulder blades. The specialist uses special twisting, bending and pressure techniques to alleviate the condition. After the first visit to the osteopath, the patient feels better. After a visit to the doctor, the pain becomes less or disappears, swelling disappears, and lightness appears. The feeling of stiffness gradually disappears and mobility returns, tension between the shoulder blades passes.

How a specialist helps patients with sore shoulder blades

Among the main advantages of osteopathic treatment of discomfort in the shoulder blade area:

  • pain disappears quickly and for a long time;
  • the specialist acts not only on the symptoms, but also on the causes of the condition;
  • doctor uses gentle techniques to treat the affected area;
  • few sessions required;
  • there is an improvement in general well-being.

Our specialists will conduct an examination and prescribe the optimal treatment.

Make an appointment for diagnostics


Pain in the shoulder blades can indicate various conditions, but more often occurs with pathologies of the musculoskeletal system. Nerve pinching and spasms of the muscular system lead to discomfort in this area. For the relief of the disease, complex therapy is required. In many cases, pain is quickly and effectively relieved by an osteopath. You can get an appointment with a specialist by leaving a request by calling the medical center.

Lumbar spondylitis – symptoms, causes, diagnosis and examinations

Spondylitis or spondyloarthritis of the lumbosacral spine refers to several specific types of arthritis.

What should be done for early diagnosis of spondylitis of the lumbosacral spine? The patient, first of all, needs to make an appointment with a rheumatologist and take an x-ray of the lumbosacral spine.

After the initial appointment, the doctor may prescribe additional examinations:

  • blood tests
  • MRI of the lumbosacral spine
  • CT scan of the lumbosacral spine.

Symptoms of spondylitis of the lumbosacral spine

All types of spondylitis of the lumbosacral spine have several common features – they cause pain and inflammation in the vertebrae. The most common symptom is back pain. Other signs depend on the type of spondylitis. Common symptoms of spondylitis include:

  • muscle weakness and pain
  • eye inflammation
  • joint pain
  • back pain
  • swelling of the arms and legs.

Ankylosing spondylitis of the lumbosacral spine

Ankylosing spondylitis of the lumbosacral spine is the most common type. It usually affects the spine, lower back, and hip joints. Ankylosing spondylitis symptoms include:

  • back pain
  • pain in the hip joints
  • stiffness and swelling of the hip joints.

Reactive spondylitis of the lumbosacral spine

Reactive spondylitis of the lumbosacral spine is a type of spondylitis that usually occurs after a bacterial infection. It may be associated with a sexually transmitted infection, such as chlamydia, or with a gastrointestinal infection caused by foods contaminated with salmonella. Reactive arthritis causes pain and inflammation in the peripheral joints, spine, and sacroiliac joints. They are located on each side of the lower spine. Patient may experience:

  • joint pain and swelling
  • skin rash
  • eye inflammation
  • pain and inflammation of the bladder and genitals.

Undifferentiated spondyloarthritis of the lumbosacral spine

This type of spondyloarthritis is called undifferentiated because it does not meet the diagnostic criteria for ankylosing spondylitis or a related disease. With undifferentiated spondylitis of the lumbosacral spine, most likely there will be no usual symptoms – back pain, skin rash, or digestive disorders. Instead it could be:

  • inflammatory back pain
  • pain in the buttocks
  • enthesitis – heel pain
  • peripheral arthritis
  • dactylitis
  • eye fatigue and inflammation.

Causes of lumbosacral spondylitis

Doctors do not fully know the causes of spondylitis of the lumbosacral spine. Some types, such as ankylosing spondylitis, may be genetic. This means that the likelihood of developing the disease is higher if someone in the family has it. There are up to 30 genes that are associated with ankylosing spondylitis. Some of them cause other types of spondyloarthritis.

Other possible causes of spondylitis include bacterial infections. There may be an increased risk of developing types such as reactive spondylitis if there is an infection of the intestines, bladder, or genitals.

Diagnosis of spondylitis of the lumbosacral spine – tests and examinations

Diagnosis and treatment of spondylitis of the lumbosacral spine is carried out by a rheumatologist. The doctor will do a physical exam and discuss your medical history to find out if you have spondyloarthritis. Tests and scans may also be needed to confirm the diagnosis, for example:

  • blood test
  • x-ray of the lumbosacral spine
  • CT scan of the lumbosacral spine
  • MRI of the lumbosacral spine
  • genetic study.

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