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Differential Diagnosis for Right Shoulder Pain

Single Most Likely Diagnosis

  • Subacromial Impingement Syndrome: The painful arc test at 130 degrees and positive Hawkins-Kennedy test are highly suggestive of subacromial impingement syndrome. The inability to scratch the back with the right arm also indicates limited range of motion, consistent with this diagnosis.

Other Likely Diagnoses

  • Rotator Cuff Tendinopathy: Given the symptoms and positive tests, rotator cuff tendinopathy, particularly of the supraspinatus tendon, is a likely consideration. The painful arc and Hawkins-Kennedy test can also be positive in rotator cuff tendinopathy.
  • Adhesive Capsulitis (Frozen Shoulder): Although less likely given the specific tests mentioned, adhesive capsulitis could still be considered, especially if there's a significant restriction in passive range of motion. However, the painful arc and Hawkins-Kennedy test are more specific for impingement.

Do Not Miss Diagnoses

  • Axillary Nerve Injury or Compression: While less common, axillary nerve issues could present with shoulder pain and limited mobility. It's crucial to assess for sensory changes or weakness in the deltoid muscle to rule out this condition.
  • Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It could present with shoulder pain and limited mobility, especially if there's associated neck pain or neurological symptoms.
  • Infection or Septic Arthritis: Although rare, infection within the shoulder joint or surrounding tissues is a medical emergency. Fever, significant swelling, or systemic symptoms would prompt a more urgent investigation.

Rare Diagnoses

  • Polymyalgia Rheumatica: This inflammatory condition can cause shoulder pain and stiffness, typically in individuals over 50 years old. It's often associated with systemic symptoms like fever and weight loss.
  • Neoplastic Conditions: Tumors, either primary in the bone or soft tissues of the shoulder or metastatic, are rare causes of shoulder pain. However, they should be considered, especially in the context of systemic symptoms or a known history of cancer.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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