Differential Diagnosis for Early Morning Shoulder Pain
- Single most likely diagnosis
- Adhesive Capsulitis (Frozen Shoulder): This condition is characterized by stiffness and pain in the shoulder joint, which can be particularly noticeable in the morning. The pain and stiffness can make it difficult to perform daily activities, and the condition often progresses gradually.
- Other Likely diagnoses
- Rotator Cuff Tendinitis: Inflammation of the tendons surrounding the shoulder joint can cause pain, especially at night or in the morning, due to the tendons being irritated or inflamed.
- Osteoarthritis: This degenerative joint disease can cause morning stiffness and pain in the shoulder, although it is less common in the shoulder compared to other joints like the hips or knees.
- Bursitis: Inflammation of the fluid-filled sacs (bursae) that cushion the joints can cause pain, especially with movement, and may be worse in the morning.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism: Although rare, referred pain from a pulmonary embolism can sometimes be felt in the shoulder, especially if the embolism is large and affects the upper parts of the lung. This is a medical emergency.
- Myocardial Infarction (Heart Attack): Similar to pulmonary embolism, in some cases, the pain from a heart attack can radiate to the shoulder, making it crucial to consider, especially in patients with risk factors for cardiovascular disease.
- Pancoast Tumor: A type of lung cancer located at the top of the lung, which can cause shoulder pain due to local invasion of the tumor into the brachial plexus or other structures.
- Rare diagnoses
- Polymyalgia Rheumatica: An inflammatory condition that causes muscle pain and stiffness, particularly in the shoulders, which is worse in the morning and improves throughout the day.
- Rheumatoid Arthritis: Although more commonly affecting the hands and feet, rheumatoid arthritis can also cause shoulder pain and stiffness, especially in the morning.
- Septic Arthritis: A bacterial infection within the joint, which can cause severe pain, swelling, and stiffness, and is a medical emergency requiring prompt treatment.