Differential Diagnosis for Intense Shoulder Pain Especially at Night

• Single Most Likely Diagnosis
  • Adhesive Capsulitis (Frozen Shoulder): This condition is characterized by stiffness and pain in the shoulder joint, which can be particularly severe at night. The pain and stiffness can make it difficult to sleep, and the condition is common in individuals with a history of shoulder injury or surgery.
• Other Likely Diagnoses
  • Rotator Cuff Tendinitis: Inflammation of the tendons surrounding the shoulder joint can cause intense pain, especially at night when the shoulder is at rest. This condition is common in individuals who engage in repetitive overhead activities.
  • Bursitis: Inflammation of the fluid-filled sacs (bursae) that cushion the joints can cause pain and stiffness in the shoulder, which can worsen at night.
  • Osteoarthritis: Wear and tear on the shoulder joint can cause pain and stiffness, especially at night, as the joint becomes more inflamed and irritated.
• Do Not Miss Diagnoses
  • Thoracic Outlet Syndrome: Compression of the nerves and blood vessels in the thoracic outlet can cause pain and numbness in the shoulder and arm, which can worsen at night. Missing this diagnosis can lead to permanent nerve damage.
  • Pancoast Tumor: A type of lung cancer that can cause shoulder pain, especially at night, due to compression of the nerves and blood vessels. Missing this diagnosis can lead to delayed treatment and poor outcomes.
  • Infectious Arthritis: Bacterial or fungal infections of the shoulder joint can cause severe pain and stiffness, which can worsen at night. Missing this diagnosis can lead to joint destruction and permanent damage.
• Rare Diagnoses
  • Polymyalgia Rheumatica: An inflammatory condition that can cause pain and stiffness in the shoulders and hips, especially at night. This condition is rare but can be associated with giant cell arteritis, which requires prompt treatment.
  • Sickle Cell Crisis: A condition that can cause severe pain in the shoulders and other joints due to sickling of red blood cells. This condition is rare but requires prompt treatment to prevent complications.
  • Referred Pain from Abdominal or Thoracic Pathology: Pain from abdominal or thoracic conditions, such as gallbladder disease or pulmonary embolism, can be referred to the shoulder, especially at night. These conditions are rare but require prompt diagnosis and treatment to prevent serious complications.