Differential Diagnosis for Shooting Pain Radiating Down One Arm
Single Most Likely Diagnosis
- Cervical Radiculopathy: This condition is the most likely cause of shooting pain radiating down one arm, as it involves compression or irritation of the nerve roots in the cervical spine. Justification: The symptoms of cervical radiculopathy, such as pain, numbness, and tingling, are consistent with the patient's presentation.
- Investigations: MRI or CT scan of the cervical spine, electromyography (EMG) and nerve conduction studies (NCS).
- Treatment: Physical therapy, pain management with medications, and potentially surgery if conservative measures fail.
Other Likely Diagnoses
- Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass through the thoracic outlet, leading to pain and numbness in the arm. Justification: The patient's symptoms could be consistent with thoracic outlet syndrome, especially if there is a history of trauma or repetitive strain.
- Investigations: X-rays, MRI or CT scan of the thoracic outlet, EMG and NCS.
- Treatment: Physical therapy, pain management with medications, and potentially surgery if conservative measures fail.
- Brachial Plexus Injury: This condition involves damage to the brachial plexus, a network of nerves that control arm and hand function. Justification: A brachial plexus injury could cause shooting pain radiating down the arm, especially if there is a history of trauma.
- Investigations: MRI or CT scan of the brachial plexus, EMG and NCS.
- Treatment: Physical therapy, pain management with medications, and potentially surgery if conservative measures fail.
Do Not Miss Diagnoses
- Acute Coronary Syndrome: Although less likely, acute coronary syndrome (e.g., myocardial infarction) can present with arm pain, especially if the pain is radiating down the left arm. Justification: Missing this diagnosis could be fatal, so it is essential to consider it in the differential diagnosis.
- Investigations: Electrocardiogram (ECG), troponin levels, and cardiac enzymes.
- Treatment: Immediate medical attention, including administration of aspirin, nitrates, and beta blockers, and potentially thrombolytic therapy or percutaneous coronary intervention.
- Pulmonary Embolism: A pulmonary embolism can cause sudden onset of arm pain, especially if the embolism is large and causes cardiac strain. Justification: Like acute coronary syndrome, missing this diagnosis could be fatal.
- Investigations: D-dimer levels, CT pulmonary angiogram, and ventilation-perfusion scan.
- Treatment: Anticoagulation therapy, and potentially thrombolytic therapy or surgical embolectomy.
Rare Diagnoses
- Pancoast Tumor: A Pancoast tumor is a type of lung cancer that can cause arm pain by invading the brachial plexus. Justification: Although rare, a Pancoast tumor is a possible cause of shooting pain radiating down one arm.
- Investigations: Chest X-ray, CT scan of the chest, and biopsy.
- Treatment: Surgery, radiation therapy, and chemotherapy.
- Multiple Sclerosis: Multiple sclerosis is a demyelinating disease that can cause arm pain, numbness, and tingling. Justification: Although rare, multiple sclerosis is a possible cause of shooting pain radiating down one arm, especially if there are other neurological symptoms.
- Investigations: MRI of the brain and spinal cord, evoked potentials, and lumbar puncture.
- Treatment: Disease-modifying therapies, such as interferons and glatiramer acetate, and symptomatic treatments, such as pain management and physical therapy.