Differential Diagnosis for Right Shoulder Pain
The patient presents with right shoulder pain that has intensified over the past couple of days, with significant pain upon movement and extension of the arm. Given her occupation as a nurse and the physical demands of her job, several diagnoses should be considered.
- Single Most Likely Diagnosis
- Rotator Cuff Tendinitis or Strain: This is the most likely diagnosis given the patient's occupation, which involves heavy lifting and pushing. The rotator cuff is prone to injury from repetitive strain, and the patient's symptoms of pain with movement and extension of the arm are consistent with this diagnosis.
- Other Likely Diagnoses
- Adhesive Capsulitis (Frozen Shoulder): Although less likely than rotator cuff tendinitis, adhesive capsulitis could be a consideration, especially if the patient has a history of diabetes or other conditions that predispose to this condition. The pain and limited mobility are consistent with this diagnosis.
- Bursitis: Inflammation of the bursae around the shoulder joint could cause pain, especially with movement. Given the patient's occupation and the absence of a known injury, bursitis is a plausible diagnosis.
- Labral Tear: A tear in the labrum, the cartilage surrounding the socket of the shoulder joint, could cause pain, especially with movement of the arm. This diagnosis might be less likely without a history of trauma but should be considered given the patient's symptoms.
- Do Not Miss Diagnoses
- Septic Arthritis or Osteomyelitis: Although unlikely, these conditions are medical emergencies that require prompt diagnosis and treatment. The patient's pain and limited mobility could be indicative of a septic joint or bone infection, especially if she has a fever or other systemic symptoms.
- Fracture: A fracture of the humerus, scapula, or clavicle could cause severe pain and limited mobility. While the patient does not recall a recent injury, a fracture should be ruled out, especially if the pain is severe and accompanied by swelling or deformity.
- Rare Diagnoses
- Referred Pain from the Cervical Spine: Pain from the cervical spine can refer to the shoulder. Conditions like cervical radiculopathy or a herniated disc could cause shoulder pain, although this would be less likely given the patient's occupation and the nature of her symptoms.
- Neoplastic Processes: Tumors, either benign or malignant, affecting the shoulder or surrounding structures are rare but should be considered if the patient's pain does not respond to typical treatments or if there are systemic symptoms like weight loss or night pain.