Differential Diagnosis for Sudden Pain under the Clavicle
Single Most Likely Diagnosis
- Costoclavicular syndrome: This condition, also known as thoracic outlet syndrome, involves compression of the nerves and/or blood vessels between the clavicle and the first rib or thoracic vertebra, leading to pain in the area under the clavicle. It can occur without any specific injury, especially in individuals with poor posture, anatomical abnormalities, or those who perform repetitive motions.
Other Likely Diagnoses
- Muscle strain: Strain of the muscles around the clavicle, such as the pectoralis minor, scalene, or trapezius muscles, can cause sudden pain under the clavicle without an apparent injury. This could be due to overuse or sudden contraction.
- Cervical spine referral pain: Problems in the cervical spine, such as a herniated disc or facet joint syndrome, can refer pain to the area under the clavicle due to the common nerve roots involved.
- Gallbladder disease: Gallstones or cholecystitis can cause referred pain to the right shoulder or under the right clavicle, especially if the gallbladder is inflamed.
Do Not Miss Diagnoses
- Pulmonary embolism: Although less common, a pulmonary embolism can cause sudden, severe pain under the clavicle, especially if the embolism is large and affects the upper parts of the lung. This is a medical emergency.
- Myocardial infarction: In some cases, a heart attack can cause referred pain to the shoulder or under the clavicle, especially in women or individuals with diabetes.
- Aortic dissection: A tear in the aorta can cause severe, sudden pain that may be referred to the area under the clavicle, depending on the location of the dissection.
Rare Diagnoses
- Pancoast tumor: A rare type of lung cancer located at the apex of the lung can cause pain under the clavicle due to local invasion of nerves and structures.
- Thoracic outlet syndrome due to a cervical rib: Presence of an extra rib (cervical rib) can compress nerves and vessels, leading to thoracic outlet syndrome.
- Apical pneumothorax: A small pneumothorax (collapsed lung) at the apex of the lung can cause pain under the clavicle, though this would typically be accompanied by respiratory symptoms.