Differential Diagnosis for Shoulder Pain Radiating Down Bicep

Single Most Likely Diagnosis

• Bicipital Tendinitis: This condition involves inflammation of the tendon that connects the bicep muscle to the shoulder joint. The pain typically starts in the front of the shoulder and can radiate down the bicep, matching the described symptomatology. Activities that involve repetitive lifting or overhead movements can exacerbate this condition.

Other Likely Diagnoses

• Subacromial Bursitis: Inflammation of the bursa that cushions the rotator cuff tendons can cause pain in the front of the shoulder that may radiate down the arm, including the bicep area. This condition often results from repetitive motion or direct trauma to the shoulder.
• Rotator Cuff Strain or Tear: While the primary symptom of a rotator cuff injury is usually weakness and pain in the shoulder, some individuals may experience pain radiating down the bicep, especially if the supraspinatus tendon is involved.
• 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 your shoulders and neck and can sometimes radiate down the arm, potentially affecting the bicep area.

Do Not Miss Diagnoses

• Myocardial Infarction (Heart Attack): Although less common, cardiac issues like a myocardial infarction can sometimes present with referred pain in the shoulder or arm, including the bicep area. This is particularly concerning in individuals with risk factors for heart disease.
• Cervical Radiculopathy: Compression or irritation of the nerves exiting the cervical spine can cause pain, numbness, or weakness in the neck and arm. While the pattern of pain can vary, it's crucial to consider this diagnosis to avoid missing a potentially serious condition.

Rare Diagnoses

• Pancoast Tumor: A rare type of lung cancer located at the top of the lung, which can cause shoulder pain that radiates down the arm due to the involvement of the brachial plexus.
• Neurological Conditions (e.g., Multiple Sclerosis, Peripheral Neuropathy): Certain neurological conditions can cause a wide range of symptoms, including pain in unusual distributions. While these are less likely causes of the described symptom, they should be considered in the appropriate clinical context.

Each of these diagnoses has a different set of implications for treatment and management, emphasizing the importance of a thorough evaluation to determine the underlying cause of the pain.