Differential Diagnosis for Right Shoulder Pain

The patient presents with right shoulder pain, a burning sensation, pain on inspiration, and a "popping" sensation in the shoulder. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Musculoskeletal Strain or Sprain: Although the patient denies trauma, a musculoskeletal strain or sprain could still occur due to overuse or minor, unnoticed injury. The "popping" sensation and pain in the shoulder area support this diagnosis.
• Other Likely Diagnoses
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause pain in the rib area that radiates to the back and worsens with deep breathing.
  • Precordial Catch Syndrome: A condition characterized by sharp, stabbing pain in the chest or shoulder area, often accompanied by a "popping" sensation, which can be exacerbated by deep breathing.
  • Thoracic Outlet Syndrome: Compression of the nerves or blood vessels in the thoracic outlet can cause pain in the shoulder and chest area, as well as paresthesia or weakness in the arm.
• Do Not Miss Diagnoses
  • Pulmonary Embolism: Although less likely, a pulmonary embolism can cause sudden onset of chest pain that worsens with deep breathing. It is essential to consider this diagnosis due to its high mortality rate if left untreated.
  • Myocardial Infarction: Chest pain that radiates to the back or shoulder area can be a symptom of a myocardial infarction, especially in women. It is crucial to rule out this diagnosis due to its potential severity.
  • Pneumothorax: A collapsed lung can cause sudden onset of chest pain that worsens with deep breathing. This diagnosis should not be missed due to its potential for serious complications.
• Rare Diagnoses
  • Tietze's Syndrome: A rare condition characterized by inflammation of the cartilage that connects the ribs to the breastbone, causing pain in the chest and shoulder area.
  • Sickle Cell Crisis: A condition that can cause sudden onset of chest pain due to vaso-occlusion in the lungs. Although rare, it should be considered in patients with a history of sickle cell disease.