Differential Diagnosis for 51-year-old Male with Shoulder Injury
Single Most Likely Diagnosis
- Rotator Cuff Injury: Given the presence of low-grade intrasubstance insertional tearing involving the subscapularis, near-complete rupture of the supraspinatus tendon, and adhesive capsulitis, the most likely diagnosis is a rotator cuff injury. This condition is common in individuals over 40 years old and can result from acute trauma or chronic wear and tear.
Other Likely Diagnoses
- Adhesive Capsulitis: Although mentioned in the question, adhesive capsulitis (frozen shoulder) is a likely diagnosis that can coexist with rotator cuff injuries. It is characterized by inflammation and scarring of the joint capsule, leading to pain and stiffness.
- Subacromial Impingement: This condition occurs when the tendons of the rotator cuff are compressed between the humeral head and the acromion, leading to inflammation and pain. It can be a contributing factor to rotator cuff injuries.
- Tendinosis: Chronic wear and tear of the tendons can lead to tendinosis, which can cause pain and weakness in the affected shoulder.
Do Not Miss Diagnoses
- Axillary Nerve Injury: Although less likely, an axillary nerve injury can occur in conjunction with shoulder trauma and can result in significant morbidity if missed. It is essential to assess for axillary nerve function.
- Proximal Humerus Fracture: A fracture of the proximal humerus can be masked by the presence of rotator cuff injuries and adhesive capsulitis. It is crucial to evaluate for any bony abnormalities.
- Infection or Septic Arthritis: Although rare, infection or septic arthritis can occur in the shoulder joint, especially if there is a history of recent trauma or surgery. It is essential to consider this diagnosis to avoid delayed treatment.
Rare Diagnoses
- Quadrilateral Space Syndrome: This rare condition occurs when the axillary nerve is compressed in the quadrilateral space, leading to pain and weakness in the shoulder.
- Suprascapular Neuropathy: Compression of the suprascapular nerve can cause pain and weakness in the shoulder, especially in the supraspinatus and infraspinatus muscles.
- Glenohumeral Arthritis: Although less common in this age group, glenohumeral arthritis can cause pain and stiffness in the shoulder, and it is essential to consider this diagnosis in the differential.