Differential Diagnosis of Shoulder Pain
The differential diagnosis of shoulder pain can be organized into the following categories:
- Single Most Likely Diagnosis
- Rotator cuff tendinitis: This is the most common cause of shoulder pain, often resulting from repetitive strain or acute injury to the rotator cuff muscles and tendons.
- Other Likely Diagnoses
- Adhesive capsulitis (frozen shoulder): Characterized by stiffness and limited range of motion in the shoulder joint, often following trauma or inflammation.
- Bursitis: Inflammation of the bursae, fluid-filled sacs that cushion the joints, can cause pain and swelling in the shoulder.
- Osteoarthritis: Wear and tear on the joint cartilage can lead to pain, stiffness, and limited mobility in the shoulder.
- Labral tears: Tears in the labrum, a cartilage ring surrounding the socket of the shoulder joint, can cause pain and instability.
- Do Not Miss Diagnoses
- Pulmonary embolism: Referred pain from a pulmonary embolism can manifest as shoulder pain, making it crucial to consider this diagnosis, especially in patients with risk factors.
- Myocardial infarction: Referred pain from a heart attack can also present as shoulder pain, emphasizing the need for a thorough cardiovascular evaluation.
- Spinal cord injury or cervical radiculopathy: Nerve compression or injury in the cervical spine can cause radiating pain to the shoulder, necessitating a careful neurological examination.
- Infection (septic arthritis or osteomyelitis): Bacterial or fungal infections in the shoulder joint or bone can lead to severe pain, swelling, and potential long-term damage if not promptly treated.
- Rare Diagnoses
- Rheumatoid arthritis: Although less common in the shoulder, rheumatoid arthritis can cause inflammation, pain, and stiffness in the joint.
- Polymyalgia rheumatica: This inflammatory condition can cause widespread muscle pain, including the shoulder region.
- Pancoast tumor: A rare type of lung cancer that can cause shoulder pain due to local invasion of the tumor.
- Brachial plexus injury: Trauma to the brachial plexus nerves can result in shoulder pain, numbness, and weakness.