Differential Diagnosis for 77-year-old Female with Post-Fall Shoulder Pain
Single Most Likely Diagnosis
- Rotator Cuff Tear: Given the MRI findings of extensive full-thickness tearing of the rotator cuff with muscular atrophy, this is the most likely diagnosis. The patient's age and history of a fall also support this diagnosis, as rotator cuff tears are common in older adults and can be caused by trauma.
Other Likely Diagnoses
- AC Joint Osteoarthritis: The MRI findings of moderate to severe AC joint osteoarthrosis suggest that this condition is also likely contributing to the patient's shoulder pain.
- Labral Tear: The suspected circumferential labral tearing greater superiorly and anteriorly on the MRI suggests that a labral tear is also a possible diagnosis.
- Biceps Tendinopathy: The displacement of the intact biceps tendon medially at the bicipital groove on the MRI suggests that biceps tendinopathy may also be present.
Do Not Miss Diagnoses
- Proximal Humerus Fracture: Although the XR is normal, it is possible that a fracture was missed, especially if the patient has osteoporosis. A fracture would require prompt treatment to prevent further complications.
- Brachial Plexus Injury: A fall can cause a brachial plexus injury, which would require urgent evaluation and treatment to prevent long-term nerve damage.
- Infection or Septic Arthritis: Although less likely, infection or septic arthritis can cause shoulder pain and would require prompt treatment with antibiotics to prevent serious complications.
Rare Diagnoses
- Adhesive Capsulitis: Also known as frozen shoulder, this condition can cause shoulder pain and stiffness, but it is less likely given the patient's history of a fall and the MRI findings.
- Tumor or Cyst: A tumor or cyst in the shoulder region could cause pain, but this would be a rare diagnosis and would require further evaluation with imaging studies or biopsy.