Differential Diagnosis for Subscapular Pain after Massage and Sleeping Wrong
Single Most Likely Diagnosis
- Musculoskeletal Strain: This is the most likely diagnosis given the history of recent massage and sleeping in an awkward position, which can cause strain to the muscles and ligaments in the subscapular region.
Other Likely Diagnoses
- Subscapular Bursitis: Inflammation of the bursa under the scapula can cause pain in the subscapular region, especially after activities that involve pressure or friction on the area, such as massage.
- Rhomboid Strain: The rhomboid muscles are located in the upper back and can cause subscapular pain when strained, which could be exacerbated by sleeping in an awkward position.
- Scapulothoracic Bursitis: Similar to subscapular bursitis, inflammation of the bursa between the scapula and thoracic wall can cause pain in the area, potentially worsened by massage or improper sleeping posture.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less likely, pulmonary embolism can present with sudden onset of back pain, including subscapular pain, and is a life-threatening condition that must be considered, especially if accompanied by other symptoms like shortness of breath or chest pain.
- Myocardial Infarction: In rare cases, myocardial infarction (heart attack) can present with back pain, including subscapular pain, particularly in women or diabetic patients, making it a critical diagnosis not to miss.
- Spinal Fracture: A fracture in the thoracic spine could cause subscapular pain and is especially concerning in individuals with osteoporosis or those who have experienced significant trauma.
Rare Diagnoses
- Pancoast Tumor: A rare type of lung cancer that can cause shoulder and subscapular pain due to its location at the top of the lung, potentially involving nearby structures.
- Thoracic Outlet Syndrome: Compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib) can cause pain in the shoulder and subscapular area, though it's less commonly associated directly with subscapular pain.
- Sickle Cell Crisis: In patients with sickle cell disease, a crisis can cause severe pain episodes, including back pain, though subscapular pain would be an uncommon presentation.