Differential Diagnosis for Right Shoulder and Rhomboid Pain
Single Most Likely Diagnosis
- Musculoskeletal strain or overuse: Given the absence of injury, musculoskeletal strain or overuse is a common cause of shoulder and rhomboid pain, especially in individuals with poor posture, muscle imbalances, or those who engage in repetitive activities that strain these muscles.
Other Likely Diagnoses
- Thoracic outlet syndrome: This condition involves compression of the nerves and/or blood vessels that pass through the thoracic outlet (the space between your collarbone and first rib), which can cause pain in the shoulder and rhomboid area.
- Scapulothoracic bursitis: Inflammation of the bursae located between the scapula and the thoracic wall can cause pain in the rhomboid area.
- Cervical radiculopathy: Nerve root irritation in the cervical spine can refer pain to the shoulder and rhomboid region.
- Chronic kidney disease (CKD) related musculoskeletal pain: CKD stage 3 can lead to various musculoskeletal complaints, including pain, due to secondary hyperparathyroidism, osteodystrophy, or other metabolic imbalances.
Do Not Miss Diagnoses
- Pulmonary embolism: Although less common, pulmonary embolism can present with sudden onset shoulder or chest pain and must be considered, especially in patients with risk factors for thromboembolic events.
- Aortic dissection: This is a life-threatening condition that can cause severe, tearing chest pain that may radiate to the back or shoulder.
- Myocardial infarction: Atypical presentations of myocardial infarction can include shoulder or arm pain without chest pain, particularly in women or diabetic patients.
Rare Diagnoses
- Pancoast tumor: A type of lung cancer located at the apex of the lung, which can cause shoulder pain due to local invasion of the brachial plexus or adjacent structures.
- Multiple myeloma: A plasma cell malignancy that can cause bone pain, including in the shoulder or spine, due to lytic lesions.
- Polymyalgia rheumatica: An inflammatory condition that causes muscle pain and stiffness, typically in the shoulders, hips, and neck, often associated with elevated inflammatory markers.