Differential Diagnosis for Spinal Chord Pain
The patient presents with daily pain down the spinal chord, leading to referred pain in the back, neck, and upper shoulders, with dull achy sensations on the sides of the spinal chord that feel better with deep pressure. Here's a categorized differential diagnosis:
- Single Most Likely Diagnosis
- Musculoskeletal Strain or Tension: This is the most likely diagnosis given the description of pain and the relief with deep pressure. Musculoskeletal issues, including strain or tension in the muscles along the spine, can cause pain that radiates to the neck and shoulders.
- Other Likely Diagnoses
- Herniated Disc: A herniated disc can cause pain that radiates along the spinal chord and into the neck and shoulders, depending on the location of the herniation.
- Degenerative Disc Disease: This condition can lead to chronic pain in the spine, neck, and shoulders due to the degeneration of the spinal discs.
- Fibromyalgia: Characterized by widespread musculoskeletal pain, fibromyalgia could be a consideration, especially if the pain is widespread and accompanied by other symptoms like fatigue and sleep disturbances.
- Do Not Miss Diagnoses
- Spinal Stenosis: A narrowing of the spinal canal, which can cause pain, numbness, or weakness in the back, neck, and shoulders. It's crucial to identify this condition due to its potential for significant neurological impairment.
- Multiple Myeloma: A type of blood cancer that can cause bone pain, including pain in the spine. Early detection is critical for treatment outcomes.
- Spinal Cord Tumors: Both benign and malignant tumors can cause spinal cord compression, leading to pain and neurological symptoms. Prompt diagnosis is essential to prevent permanent neurological damage.
- Infectious Diseases (e.g., Osteomyelitis, Discitis): Infections of the spine can cause severe pain and have serious consequences if not treated promptly.
- Rare Diagnoses
- Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. Some types can lead to spinal instability and pain.
- Scheuermann's Disease: A condition that affects the thoracic or cervical spine, leading to kyphosis (a forward rounding of the back) and can cause back pain.
- Tarlov Cysts: Abnormal fluid-filled sacs that can form on the nerve roots in the spine, potentially causing pain and neurological symptoms.
Each of these diagnoses requires careful consideration of the patient's full clinical picture, including history, physical examination, and potentially, diagnostic imaging and laboratory tests to determine the underlying cause of the symptoms.