Differential Diagnosis

The patient presents with a complex array of symptoms including chest pain radiating to the left shoulder and arm, joint pain and swelling in fingers, elevated blood pressure, and significant fatigue. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Musculoskeletal Pain: The patient's symptoms of chest pain radiating to the left shoulder and arm, joint pain and swelling in fingers, and pain triggered by work activities are suggestive of musculoskeletal pain, possibly related to the patient's occupation as a healthcare assistant. The presence of tenderness in the acromioclavicular joint, positive empty can test, and pain on internal rotation against resistance support this diagnosis.
• Other Likely Diagnoses
  • Angina or Cardiac Ischemia: Although the patient's chest pain is atypical (sharp, pinching, and radiating to the left shoulder and arm), it is essential to consider cardiac causes, especially given the patient's elevated blood pressure and hypercholesterolemia.
  • Osteoarthritis: The patient has a history of osteoarthritis in small joints and feet, which could contribute to the joint pain and swelling.
  • Work-Related Injury: The patient's symptoms are triggered by work activities, suggesting a possible work-related injury or strain.
• Do Not Miss Diagnoses
  • Acute Coronary Syndrome (ACS): Although the patient's symptoms are atypical, it is crucial to rule out ACS, as it is a life-threatening condition.
  • Pulmonary Embolism (PE): The patient's symptoms of chest pain and shortness of breath on exertion could be indicative of a PE, which is a medical emergency.
  • Aortic Dissection: The patient's chest pain radiating to the left shoulder and arm could be suggestive of an aortic dissection, which is a life-threatening condition.
• Rare Diagnoses
  • Tietze's Syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, which could cause chest pain and tenderness.
  • Sickle Cell Crisis: Although the patient has no known history of sickle cell disease, it is essential to consider this diagnosis, especially if the patient has not been previously screened.
  • Thoracic Outlet Syndrome: A rare condition characterized by compression of the nerves and/or blood vessels in the thoracic outlet, which could cause chest pain, arm pain, and numbness.