Differential Diagnosis for Pain in Anterior Shoulder Radiating to the Elbow

Single Most Likely Diagnosis

• Subacromial Bursitis/Tendinitis: This condition is a common cause of shoulder pain that can radiate down to the elbow, especially with movements involving abduction and external rotation of the arm. The pain is often exacerbated by overhead activities and can be associated with inflammation of the tendons and bursae around the shoulder joint.

Other Likely Diagnoses

• Rotator Cuff Strain: Strains to the muscles and tendons of the rotator cuff can cause pain in the anterior shoulder that may radiate to the elbow, particularly with movements that involve lifting or rotating the arm.
• Cervical Radiculopathy: Compression or irritation of the cervical nerve roots can cause pain that radiates from the neck down to the shoulder and elbow, often accompanied by numbness, tingling, or weakness in the arm.
• Thoracic Outlet Syndrome: Compression of the nerves and/or blood vessels that pass through the thoracic outlet (the space between the collarbone and first rib) can cause pain in the shoulder and arm, including radiation to the elbow, along with numbness, tingling, and weakness.

Do Not Miss Diagnoses

• Myocardial Infarction (MI): Although less common, pain in the shoulder and arm can be a referred pain from a myocardial infarction, especially if the pain is accompanied by other symptoms such as chest pain, shortness of breath, or diaphoresis. Missing this diagnosis can be fatal.
• Pulmonary Embolism: In rare cases, a pulmonary embolism can cause referred pain to the shoulder and arm, particularly if the embolism involves the upper lobe of the lung. This condition requires immediate medical attention.

Rare Diagnoses

• Pancoast Tumor: A rare type of lung cancer located at the apex of the lung, which can cause shoulder and arm pain due to invasion of the brachial plexus and adjacent structures.
• Osteonecrosis of the Humeral Head: A condition where the blood supply to the humeral head is interrupted, leading to necrosis of the bone tissue, which can cause shoulder pain radiating to the elbow.
• Infectious or Inflammatory Arthritis: Certain types of arthritis, such as septic arthritis or rheumatoid arthritis, can cause pain in the shoulder joint that may radiate to the elbow, although these conditions are less common in this presentation.