Differential Diagnosis for Shoulder Pain with Radiating Arm Pain
Single Most Likely Diagnosis
- Rotator Cuff Tendinopathy or Impingement: This condition is common in individuals who engage in repetitive overhead activities, such as playing pickle ball. The pain at the shoulder joint and radiating down the arm could be due to inflammation or irritation of the rotator cuff tendons, which can also impinge on nearby nerves, causing nerve-like pain.
Other Likely Diagnoses
- Adhesive Capsulitis (Frozen Shoulder): Although it typically presents with stiffness and limited range of motion, pain at the shoulder joint that radiates down the arm can occur, especially if there's associated nerve irritation.
- Cervical Radiculopathy: Given the description of pain radiating down the arm like nerve pain, cervical radiculopathy (nerve root irritation in the neck) is a plausible diagnosis, as it can cause pain and numbness in the arm.
- Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib), which can cause pain in the shoulder and arm.
Do Not Miss Diagnoses
- Cervical Spine Fracture or Dislocation: Although the patient does not recall an injury, it's crucial to consider the possibility of a cervical spine fracture or dislocation, especially if there was a traumatic event during pickle ball that might have been overlooked.
- Brachial Plexus Injury: A severe injury to the brachial plexus (the network of nerves that conducts signals from the spinal cord to the shoulder, arm, and hand) could present with arm pain and must be considered to prevent long-term damage.
- Pancoast Tumor: A rare type of lung cancer located at the top of the lung, which can cause shoulder and arm pain due to invasion of nearby nerves.
Rare Diagnoses
- Osteonecrosis of the Humeral Head: A condition where the blood supply to the humeral head (the top of the upper arm bone) is interrupted, leading to bone death and potentially causing shoulder pain.
- Infectious or Inflammatory Arthritis: Conditions such as septic arthritis or rheumatoid arthritis can cause shoulder pain and must be considered, especially if there are systemic symptoms like fever or if the pain is accompanied by significant stiffness and swelling.