Differential Diagnosis for Unbearable Night Pain in the Clavicle and Shoulder
Single Most Likely Diagnosis
- Metastatic breast cancer: Given the patient's history of Stage 2a breast cancer 8 years prior, the most likely diagnosis is metastatic disease to the bone, which is a common site for breast cancer metastasis. Night pain, especially in the clavicle and shoulder, can be indicative of bone metastasis.
Other Likely Diagnoses
- Osteoarthritis or degenerative joint disease: Age-related wear and tear on the joints can cause night pain in the shoulder and clavicle area.
- Rotator cuff tendinitis or tear: Common in this age group, rotator cuff issues can cause significant pain, especially at night.
- Referred pain from cervical spine disease: Cervical spine conditions like herniated discs or spinal stenosis can refer pain to the shoulder and clavicle area.
Do Not Miss Diagnoses
- Pathological fracture: A fracture through a weakened area of bone, which could be due to metastatic disease or osteoporosis. This is a medical emergency.
- Infection (osteomyelitis or septic arthritis): Although less likely, infection in the bone or joint can cause severe pain and must be promptly treated to avoid serious complications.
- Thoracic outlet syndrome: Compression of the nerves or blood vessels between the clavicle and first rib can cause severe pain and other symptoms.
Rare Diagnoses
- Paget's disease of bone: A condition characterized by an abnormal breakdown and regrowth of bone tissue, which can cause bone pain.
- Multiple myeloma: A type of blood cancer that can cause bone pain, although it is less common than metastatic breast cancer in this context.
- Ewing's sarcoma or other primary bone tumors: Although rare, especially in this age group, primary bone tumors can cause night pain and must be considered in the differential diagnosis.