Differential Diagnosis for Shoulder Pain with Pressure on the Scapula and Reaching Across the Body

• Single Most Likely Diagnosis

  • Subacromial Bursitis or Rotator Cuff Tendinitis: These conditions are common causes of shoulder pain, especially with movements that involve reaching across the body or pressure on the scapula. The pain is typically localized to the shoulder region and can be exacerbated by specific movements.

• Other Likely Diagnoses

  • Adhesive Capsulitis (Frozen Shoulder): Characterized by pain and stiffness in the shoulder, adhesive capsulitis can cause pain when reaching across the body or applying pressure on the scapula. The condition often progresses through stages, starting with pain, followed by stiffness, and then recovery.
  • Scapulothoracic Bursitis: Inflammation of the bursae between the scapula and the thoracic wall can cause pain with pressure on the scapula and certain movements of the arm.
  • 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 shoulder pain, especially with movements that involve reaching across the body.

• Do Not Miss Diagnoses

  • Pulmonary Embolism: Although less common, a pulmonary embolism can refer pain to the shoulder region, especially if the embolism is large and involves the upper parts of the lung. The pain can be worsened by deep breathing or certain movements.
  • Myocardial Infarction (Heart Attack): In some cases, a heart attack can cause referred pain to the shoulder, especially the left shoulder. This is due to the shared nerve roots between the heart and the shoulder.
  • Pancoast Tumor: A type of lung cancer located at the top of the lung, a Pancoast tumor can cause shoulder pain due to local invasion of the tumor into the brachial plexus or the shoulder structures.

• Rare Diagnoses

  • Osteonecrosis of the Humeral Head: A condition where the blood supply to the humeral head is interrupted, leading to bone death. It can cause shoulder pain, especially with movement.
  • Inflammatory Arthritis (e.g., Rheumatoid Arthritis, Psoriatic Arthritis): These conditions can cause shoulder pain and stiffness, although they are less common causes of the specific symptoms described.
  • Polymyalgia Rheumatica: An inflammatory condition that causes muscle pain and stiffness, typically in the shoulders and hips. It can cause pain with movement and pressure on the affected areas.