Differential Diagnosis for 25 yo with Rt Shoulder Blade Pain/Neck Pain
Single Most Likely Diagnosis
- Musculoskeletal strain or injury: The patient's symptoms started after lifting a heavy weight, which suggests a mechanical cause for the pain. The persistence of pain despite treatment could be due to inadequate rehabilitation or ongoing strain.
Other Likely Diagnoses
- Cervical spondylosis or disc herniation: The pain in the neck and shoulder blade area, exacerbated by movement of the head, could indicate a cervical spine issue. The age of the patient is relatively young for significant spondylosis, but disc herniation is possible.
- Thoracic outlet syndrome: This condition involves compression of the nerves and/or blood vessels that pass through the thoracic outlet (the space between the collarbone and first rib), which could cause pain in the shoulder and neck area.
- Scapulothoracic bursitis or snapping scapula syndrome: Inflammation of the bursae around the scapula or abnormal movement of the scapula against the thoracic wall could cause pain in the shoulder blade area.
Do Not Miss Diagnoses
- Aortic dissection: Although less common in young individuals without a history of hypertension or connective tissue disorders, aortic dissection is a life-threatening condition that could present with sudden onset of severe back or neck pain. The unpredictable nature of the pain and its relation to movement could be misleading.
- Pulmonary embolism: While typically presenting with respiratory symptoms, a pulmonary embolism could cause sudden onset of chest or back pain, which might be referred to the shoulder or neck area.
- Spinal infection or tumor: Infections like osteomyelitis or discitis, or tumors, could cause persistent and severe back or neck pain, often with systemic symptoms like fever or weight loss.
Rare Diagnoses
- Pancoast tumor: A type of lung cancer located at the apex of the lung, which could cause shoulder and neck pain due to invasion of nearby structures.
- Ehlers-Danlos syndrome or other connective tissue disorders: These conditions could predispose to musculoskeletal injuries, joint instability, or vascular complications, potentially explaining the patient's symptoms and their persistence.
- Osteonecrosis of the scapula or humerus: Although rare, osteonecrosis could cause persistent pain in the shoulder or neck area, especially if related to trauma or steroid use.