Differential Diagnosis for Arm and Shoulder Complaints
The following differential diagnosis is organized into categories to help guide the thought process.
- Single Most Likely Diagnosis
- Musculoskeletal Strain or Sprain: This is often the most common cause of arm and shoulder pain, typically resulting from overuse, injury, or poor posture. Justification: High prevalence, common presentation, and often related to recent activity or trauma.
- Other Likely Diagnoses
- Tendinitis or Bursitis: Inflammation of the tendons or bursae around the shoulder joint can cause significant pain and limited mobility. Justification: Common conditions, especially in individuals who perform repetitive motions or have jobs involving heavy lifting.
- Cervical Radiculopathy: Nerve root compression in the cervical spine can radiate pain to the arms and shoulders. Justification: A frequent cause of arm pain, especially when accompanied by neck pain or stiffness.
- Thoracic Outlet Syndrome: Compression of the nerves or blood vessels between the collarbone and first rib can lead to arm and shoulder pain. Justification: Considered when there's a history of trauma, poor posture, or anatomical abnormalities.
- Do Not Miss Diagnoses
- Myocardial Infarction: Although less common, arm pain can be a presenting symptom of a heart attack, especially if the pain is radiating or accompanied by other cardiac symptoms. Justification: Critical to diagnose promptly due to the high risk of mortality.
- Pulmonary Embolism: In rare cases, arm pain can be associated with a pulmonary embolism, particularly if there's a history of deep vein thrombosis or recent immobilization. Justification: Potentially life-threatening, thus important not to miss.
- Spinal Cord Injury or Compression: Acute trauma or progressive conditions like spinal stenosis can cause arm and shoulder pain due to spinal cord compression. Justification: Urgent diagnosis and treatment are necessary to prevent permanent neurological damage.
- Rare Diagnoses
- Polymyalgia Rheumatica: An inflammatory condition that causes muscle pain and stiffness, often in the shoulders and arms. Justification: Less common, but important to consider in older adults with systemic symptoms like fever and weight loss.
- Complex Regional Pain Syndrome: A chronic pain condition characterized by severe, burning pain in the arms or shoulders, often following an injury. Justification: Rare, but significant due to its impact on quality of life and the challenge of treatment.
- Neoplastic Conditions: Tumors affecting the nerves, bones, or soft tissues in the arm or shoulder region can cause pain. Justification: Although rare, neoplastic conditions are critical to diagnose early for effective treatment and prognosis.