Differential Diagnosis for Nerve Pain on the Right Side Affecting Sleep

Single Most Likely Diagnosis

• Carpal Tunnel Syndrome or Radiculopathy: Nerve pain on one side, particularly if it affects sleeping on that side, could be due to compression or irritation of nerves in the neck or wrist. This is a common condition that can cause significant discomfort and disrupt sleep patterns.

Other Likely Diagnoses

• Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause pain in the shoulder and arm, especially when sleeping on the affected side.
• Bursitis or Tendinitis: Inflammation of the bursae or tendons around the shoulder or hip can cause localized pain that worsens with pressure or certain positions, such as sleeping on the affected side.
• Sciatica: Although typically associated with lower back pain radiating down the leg, sciatica can sometimes cause discomfort in the hip or buttock area that might be exacerbated by sleeping on the affected side.

Do Not Miss Diagnoses

• Pancreatic Cancer: Although rare, pancreatic cancer can cause referred pain to the back or side, which might worsen with certain positions, including sleeping on the affected side. Early detection is crucial for treatment outcomes.
• Spinal Cord Compression: Conditions like spinal stenosis, herniated discs, or tumors can compress the spinal cord, leading to pain, numbness, or weakness. This is a medical emergency if symptoms progress rapidly.
• Pulmonary Embolism: While less common, a pulmonary embolism can cause sudden, severe chest pain that might worsen with deep breathing or certain positions, including sleeping on the affected side.

Rare Diagnoses

• Complex Regional Pain Syndrome (CRPS): A chronic pain condition characterized by severe, burning pain at the site of an injury, which can be exacerbated by movement or pressure, including sleeping on the affected side.
• Neoplastic Processes: Tumors affecting the nerves or surrounding tissues can cause localized pain that might worsen with certain positions or activities, including sleeping on the affected side.
• Vascular Conditions: Certain vascular diseases, such as vasculitis or vascular malformations, can cause pain that might be position-dependent, including worsening with sleep on the affected side.