Differential Diagnosis for Shoulder Pain
Single Most Likely Diagnosis
- Subacromial Bursitis/Tendinitis: This condition is the most likely cause of shoulder pain that radiates around the scapula and down the arm. It involves inflammation of the bursae or tendons in the shoulder joint, often due to overuse or repetitive motion, leading to pain and limited mobility.
Other Likely Diagnoses
- Rotator Cuff Strain: A strain or tear in the rotator cuff muscles or tendons can cause pain in the shoulder that may radiate down the arm. This is common in individuals who perform repetitive overhead activities or have suffered a direct injury to the shoulder.
- Adhesive Capsulitis (Frozen Shoulder): Characterized by stiffness and pain in the shoulder joint, adhesive capsulitis can lead to pain that is felt around the scapula and may radiate down the arm, especially with movement.
- Cervical Radiculopathy: Compression or irritation of the cervical nerve roots can cause pain that radiates from the neck down into the shoulder and arm, mimicking shoulder pathology.
Do Not Miss Diagnoses
- Myocardial Infarction: Although less common, myocardial infarction (heart attack) can present with referred pain to the shoulder and down the arm, especially on the left side. It is crucial to consider cardiac causes, especially in patients with risk factors for coronary artery disease.
- Pulmonary Embolism: In rare cases, a pulmonary embolism can cause sudden onset of shoulder pain due to referred pain from the diaphragm, especially if the embolism involves the lung bases.
- Thoracic Aortic Dissection: This is a life-threatening condition where the inner layer of the aorta tears, causing severe pain that can be referred to the shoulder and arm, among other areas.
Rare Diagnoses
- Pancoast Tumor: A type of lung cancer located at the apex of the lung, which can cause shoulder pain due to local invasion of the brachial plexus or ribs.
- Referred Pain from Abdominal Pathology: Certain abdominal conditions, such as gallbladder disease or pancreatitis, can cause referred pain to the shoulder due to shared nerve roots.
- Complex Regional Pain Syndrome (CRPS): A chronic pain condition characterized by severe, burning pain at the site of an injury, which can sometimes be referred to the shoulder and arm.