Differential Diagnosis for Shoulder Pain
Single Most Likely Diagnosis
- Rotator Cuff Tendinitis: This is the most common cause of shoulder pain, often resulting from overuse or repetitive strain on the rotator cuff muscles and tendons. It typically presents with pain and stiffness in the shoulder, especially with movements involving abduction and rotation.
Other Likely Diagnoses
- Adhesive Capsulitis (Frozen Shoulder): Characterized by stiffness and limited range of motion in the shoulder, often following trauma or inflammation. It can also occur without a clear precipitant.
- Subacromial Bursitis: Inflammation of the bursa that cushions the rotator cuff tendons, leading to pain and swelling in the shoulder.
- Shoulder Impingement Syndrome: Occurs when the rotator cuff tendons are compressed against the acromion, leading to pain and limited mobility.
- Labral Tears: Tears in the cartilage surrounding the socket of the shoulder joint, often due to trauma or repetitive strain.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although less common, shoulder pain can be a referred symptom of a heart attack, especially in women. It's crucial to consider cardiac causes, especially if accompanied by other symptoms like chest pain or shortness of breath.
- Pulmonary Embolism: Can cause referred pain to the shoulder, especially if the embolism involves the upper lobe of the lung.
- Pancreatitis: In rare cases, pancreatitis can cause referred pain to the shoulder, typically accompanied by severe abdominal pain.
- Sickle Cell Crisis: Patients with sickle cell disease can experience shoulder pain due to vaso-occlusive crises.
Rare Diagnoses
- Osteonecrosis of the Humeral Head: A condition where the blood supply to the humeral head is disrupted, leading to bone death and shoulder pain.
- Tumors (Primary or Metastatic): Rarely, shoulder pain can be the presenting symptom of a tumor in the shoulder region, either primary (e.g., osteosarcoma) or metastatic (e.g., from breast or lung cancer).
- Infection (Septic Arthritis or Osteomyelitis): Infections of the shoulder joint or bone can cause severe pain, swelling, and limited mobility, often accompanied by systemic symptoms like fever.
- Polymyalgia Rheumatica: An inflammatory condition that can cause shoulder pain and stiffness, often in older adults, and is associated with elevated inflammatory markers.