History of Present Illness (HPI)

The patient is a [insert age]-year-old [insert sex] who presents with a complaint of intermittent right shoulder throbbing pain. The pain started approximately one week ago after helping a friend move, which involved heavy lifting. The patient reports that the pain progresses with movement, suggesting a possible mechanical or musculoskeletal origin.

Differential Diagnosis

• Single Most Likely Diagnosis
  • Rotator Cuff Strain or Tear: This is the most likely diagnosis given the history of heavy lifting and the nature of the pain, which worsens with movement. Rotator cuff injuries are common in individuals who engage in activities that involve lifting, pulling, or throwing, and can cause pain and weakness in the shoulder.
• Other Likely Diagnoses
  • Shoulder Impingement Syndrome: This condition occurs when the tendons of the rotator cuff muscles become irritated or inflamed as they pass under the acromion, a part of the shoulder blade. It can cause pain, especially with overhead activities or heavy lifting.
  • Bursitis: Inflammation of the bursae, fluid-filled sacs that cushion bones, tendons, and muscles near joints, can cause pain and stiffness, especially with movement.
  • Muscle Strain: Strain of the muscles around the shoulder can occur due to overuse or direct injury, leading to pain and limited mobility.
• Do Not Miss Diagnoses
  • Fracture: Although less likely, a fracture of the shoulder or upper arm could occur due to heavy lifting or a fall. Missing this diagnosis could lead to improper healing and long-term disability.
  • Axillary Nerve Injury: Damage to the axillary nerve can cause pain, weakness, and numbness in the shoulder area. This could be due to direct trauma or compression during the lifting activity.
  • 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 arm, among other symptoms.
• Rare Diagnoses
  • Osteonecrosis of the Humeral Head: A condition where the blood supply to the bone tissue at the head of the humerus is interrupted, leading to bone death. This is less common but could be a consideration in the differential diagnosis, especially if the patient has risk factors such as long-term steroid use.
  • Infectious or Inflammatory Arthritis: Conditions like septic arthritis or rheumatoid arthritis could present with shoulder pain, although they would typically have additional systemic symptoms or involve multiple joints.