Differential Diagnosis for Right Shoulder Pain
The patient's complaint of sharp pain on the right side of the shoulder when abducting her arm can be approached by considering the following categories:
- Single Most Likely Diagnosis
- Subacromial Impingement Syndrome: This condition is the most likely cause of the patient's symptoms, given the sharp pain during arm abduction. The subacromial space is narrowed, causing the rotator cuff tendons to become impinged, leading to pain and inflammation.
- Other Likely Diagnoses
- Rotator Cuff Tendinitis: Inflammation of the tendons surrounding the shoulder joint can cause pain, especially during movements like abduction.
- Bursitis: Inflammation of the bursae, fluid-filled sacs that cushion the joints, can cause pain and stiffness in the shoulder.
- Adhesive Capsulitis (Frozen Shoulder): Although typically characterized by stiffness and limited range of motion, early stages can present with pain during specific movements.
- Do Not Miss Diagnoses
- Fracture: Although less likely, a fracture of the humerus, scapula, or clavicle could cause sharp pain, especially with movement, and must be ruled out to avoid missing a potentially serious condition.
- Axillary Nerve Injury: Damage to the axillary nerve can cause pain and weakness in the shoulder region and is crucial to identify due to its implications for nerve recovery.
- Referred Pain from the Cervical Spine: Pain from cervical spine issues, such as herniated discs or cervical spondylosis, can refer to the shoulder and must be considered to ensure proper diagnosis and treatment.
- Rare Diagnoses
- Osteonecrosis of the Humeral Head: A rare condition where the blood supply to the humeral head is disrupted, leading to bone death and potentially causing shoulder pain.
- Septic Arthritis or Osteomyelitis: Infections within the shoulder joint or bone can cause severe pain and require urgent medical attention, although they are less common causes of shoulder pain in the absence of systemic symptoms or risk factors.