<s>[INST] My 4 year-old granddaughter has two small nodules, one right on top of the other, hard, immovable and painful to touch. They are located about 1/2 inch to the left of her spine just below the shoulder blade. They are not visible unless she hunches over slightly, but can be located by touch. [/INST] Hello, Regarding your concern, I would explain that these nodules could be just reactive lymph nodes. But, before coming to this conclusion, I would recommend consulting with her pediatrician for a physical exam, checking inflammation tests (complete blood count, PCR, ESR) and an ultrasound of the soft tissues in this region. Hope I have answered your query. Let me know if I can assist you further.  </s>