Differential Diagnosis for 21 yo with Pain on Right Inner Border Scapula and Right Side Neck

• Single Most Likely Diagnosis
  • Musculoskeletal Strain or Overuse Injury: Given the onset of pain after lifting heavy weights, a musculoskeletal strain or overuse injury is the most plausible diagnosis. The lack of local tenderness and the chronic nature of the pain (6 months) without relief from any treatment suggest a possible overuse or strain injury that has not been adequately addressed.
• Other Likely Diagnoses
  • Thoracic Outlet Syndrome (TOS): This condition involves compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the thoracic outlet area, which lies between your collarbone (clavicle) and first rib. Symptoms can include pain in the shoulders and neck, which aligns with the patient's complaints.
  • Scapulothoracic Bursitis: Inflammation of the bursae around the scapula can cause pain along the inner border of the scapula, which could be exacerbated by lifting heavy weights.
  • Cervical Spondylosis or Disc Herniation: Although less likely given the specific location of pain and the absence of local tenderness, cervical spine issues can refer pain to the scapular area and should be considered, especially if there are radicular symptoms.
• Do Not Miss Diagnoses
  • Pancoast Tumor: A type of lung cancer located at the top of the lung that can cause shoulder and arm pain due to invasion of the brachial plexus and other structures. It's crucial to consider this, despite its low likelihood, due to its severe implications.
  • Spinal Cord Injury or Compression: Conditions such as spinal stenosis, tumors, or infections that compress the spinal cord can present with neck and scapular pain and are critical to diagnose early to prevent permanent damage.
• Rare Diagnoses
  • Tietze's Syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, which can cause chest and scapular pain.
  • Sickle Cell Disease Crisis: Although rare and more commonly associated with other systemic symptoms, a sickle cell crisis can cause a wide range of pain complaints, including musculoskeletal pain, due to vaso-occlusive episodes.

Each of these diagnoses should be considered in the context of a thorough medical history, physical examination, and potentially, diagnostic imaging or other tests to determine the underlying cause of the patient's symptoms.