Differential Diagnosis for Shooting Pain Radiating Down One Arm
When a patient presents with shooting pain radiating down one of their arms, several conditions must be considered to provide an accurate diagnosis and appropriate treatment. The differential diagnoses can be categorized as follows:
Single Most Likely Diagnosis
- Cervical Radiculopathy: This condition, often resulting from a herniated disk or bone spur in the cervical spine, compresses or irritates a nerve root, leading to pain that radiates down the arm. The specific arm and area of pain can help identify which nerve root is affected.
Other Likely Diagnoses
- Thoracic Outlet Syndrome (TOS): This involves compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the thoracic outlet area, which lies between your collarbone (clavicle) and first rib. Symptoms can include pain in your shoulders and neck and numbness in your fingers.
- Brachial Plexus Injury: The brachial plexus is a network of nerves that come from your spinal cord and travel down your arm. These nerves control the muscles of your shoulder, elbow, wrist, and hand, as well as provide feeling in your arm. Injury to this area can cause shooting pain down the arm.
- Peripheral Neuropathy: Although more commonly associated with diabetes, peripheral neuropathy can result from various causes, including trauma, infection, and autoimmune diseases, leading to damage to the peripheral nerves and causing pain, numbness, and weakness, typically in the hands and feet but can also affect the arms.
Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although chest pain is the hallmark of ACS, including myocardial infarction (heart attack), some patients, especially women, may experience arm pain as a primary symptom. Missing this diagnosis can be fatal.
- Pulmonary Embolism: In rare cases, a pulmonary embolism can cause arm pain if it leads to a collapse of the lung, which might refer pain to the arm. This is a life-threatening condition that requires immediate medical attention.
- Aortic Dissection: This is a serious condition where there is a tear in the aorta's inner layer. It can cause severe, tearing chest pain that may radiate to the arm. Aortic dissection is a medical emergency.
Rare Diagnoses
- Pancoast Tumor: A type of lung cancer located at the top of the lung that can invade nearby tissues, including nerves, leading to shoulder and arm pain.
- Complex Regional Pain Syndrome (CRPS): A condition characterized by chronic pain, inflammation, and hypersensitivity in one of the arms or legs after an injury or trauma. The pain is typically out of proportion to the severity of the initial injury.
- Arteritis or Vasculitis: Inflammation of the blood vessels can cause a variety of symptoms, including pain in the arms, but this would be an uncommon presentation for these conditions.