Differential Diagnosis
- Single most likely diagnosis
- Bicipital tendinitis: This condition is a common cause of anterior shoulder pain, especially after a sub-pectoral tenodesis. The proximity of the biceps tendon to the surgical site and the potential for altered biomechanics post-operatively make this a plausible diagnosis.
- Other Likely diagnoses
- Adhesive capsulitis (frozen shoulder): Although less common, adhesive capsulitis can occur after shoulder surgery, leading to pain and stiffness. The anterior pain could be referred from the capsule.
- Subscapularis tendonitis or rupture: Given the sub-pectoral approach, there's a risk of injury to the subscapularis tendon, which could lead to anterior shoulder pain.
- Hardware irritation or prominence: If hardware (e.g., screws, anchors) was used during the tenodesis, it could cause irritation or become prominent, leading to anterior pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Infection: Although rare, infection is a serious complication that can occur after any surgical procedure. Persistent or severe pain, especially if accompanied by other symptoms like redness, swelling, or fever, should prompt an investigation for infection.
- Nerve injury: Damage to nerves such as the musculocutaneous nerve (supplying the biceps) or the axillary nerve could lead to significant morbidity. Anterior pain could be a symptom of nerve irritation or injury.
- Rare diagnoses
- Heterotopic ossification: This is a rare condition where bone forms outside of the skeleton, potentially causing pain and stiffness. It's an uncommon complication of surgery but should be considered in the differential diagnosis of persistent pain.
- Complex regional pain syndrome (CRPS): A rare but potentially debilitating condition characterized by chronic pain, inflammation, and hypersensitivity, which could be triggered by surgery.