Differential Diagnosis for 45 yo Male Patient with Shoulder Pain and Associated Symptoms

• Single most likely diagnosis:
  • Cervical Radiculopathy: The patient's symptoms of numbness in arms and hands, headaches, and sleep disturbance due to shoulder pain are suggestive of a cervical spine issue, such as a herniated disc or foraminal stenosis, which is compressing or irritating a nerve root, leading to radiculopathy.
• Other Likely diagnoses:
  • Rotator Cuff Tendinitis or Tear: The patient's initial complaint of shoulder pain could be due to a rotator cuff issue, which might not fully explain the numbness and headaches but could contribute to the overall pain and discomfort.
  • 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 could explain the numbness in the arms and hands, as well as shoulder pain.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Cervical Spinal Stenosis: A condition where the spinal canal narrows, potentially causing serious neurological problems, including numbness, weakness, and in severe cases, paralysis.
  • Pancoast Tumor: A type of lung cancer located at the top of the lung that can cause shoulder pain and numbness in the arm due to its invasion into nearby structures, including nerves.
• Rare diagnoses:
  • Multiple Myeloma: A type of blood cancer that can cause bone pain, including shoulder pain, and neurological symptoms if the spine is involved.
  • Amyotrophic Lateral Sclerosis (ALS): A progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord, leading to loss of muscle control, which could present with numbness and weakness in the limbs, though it's much less likely given the initial presentation focused on shoulder pain.