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Differential Diagnosis for Shoulder Pain

The differential diagnosis for shoulder pain can be organized into the following categories:

  • Single Most Likely Diagnosis
    • Rotator cuff tendinitis or strain: This is the most common cause of shoulder pain, often resulting from overuse or repetitive strain on the rotator cuff muscles and tendons.
  • Other Likely Diagnoses
    • Adhesive capsulitis (frozen shoulder): Characterized by stiffness and limited range of motion in the shoulder joint, often following trauma or inflammation.
    • Bursitis: Inflammation of the bursae, fluid-filled sacs that cushion the joints, can cause pain and swelling in the shoulder.
    • Osteoarthritis: Wear and tear on the joint cartilage can lead to pain, stiffness, and limited mobility in the shoulder.
    • Labral tears: Tears in the labrum, a cartilage ring surrounding the socket of the shoulder joint, can cause pain and instability.
  • Do Not Miss Diagnoses
    • Myocardial infarction (MI): Referred pain from the heart can manifest as shoulder pain, especially in women, and is a medical emergency.
    • Pulmonary embolism (PE): Sudden onset of shoulder pain, especially if accompanied by shortness of breath or chest pain, can be a sign of a life-threatening PE.
    • Spinal cord injury or compression: Trauma or degenerative conditions affecting the cervical spine can cause radiating pain to the shoulder and arm.
    • Infection (septic arthritis or osteomyelitis): Bacterial or fungal infections can cause severe pain, swelling, and limited mobility in the shoulder joint.
  • Rare Diagnoses
    • Polymyalgia rheumatica (PMR): An inflammatory condition that causes muscle pain and stiffness, often affecting the shoulders and hips.
    • Gout or pseudogout: Deposition of urate crystals in the joint can cause sudden, severe pain and swelling in the shoulder.
    • Tumors (primary or metastatic): Rarely, shoulder pain can be a symptom of a tumor in the bone, joint, or surrounding soft tissues.
    • Thoracic outlet syndrome: Compression of the nerves and blood vessels between the neck and shoulder can cause pain, numbness, and tingling in the shoulder and arm.

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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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