Differential Diagnosis for Shoulder Pain

The patient presents with bilateral trapezius muscle pain, ongoing for 4 weeks, without fever, cough, or cold symptoms, and is experiencing stress. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Musculoskeletal Strain or Tension: Given the patient's stress and the use of two pillows (which might indicate an attempt to alleviate discomfort or support the neck and shoulders during sleep), musculoskeletal strain or tension in the trapezius muscles is a plausible explanation. This condition is common and can be exacerbated by poor posture, stress, or overuse.

• Other Likely Diagnoses

  • Poor Posture or Ergonomic Issues: The patient's need for two pillows might suggest an issue with sleep posture or an attempt to compensate for discomfort, which could be related to ergonomic issues or poor posture during the day, leading to strain on the trapezius muscles.
  • Stress-Related Tension: Stress can lead to muscle tension, particularly in the neck and shoulder area, including the trapezius muscles. The patient's reported stress levels support this as a potential contributing factor.
  • Sleep Disturbance: Although not explicitly mentioned, the use of two pillows could imply some level of discomfort or difficulty achieving a comfortable position during sleep, potentially leading to or exacerbating shoulder pain.

• Do Not Miss Diagnoses

  • 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 pain in the shoulders and neck and is a critical diagnosis not to miss due to potential long-term nerve damage.
  • Cervical Radiculopathy: Refers to damage or irritation of the nerve roots in the cervical spine, which can cause pain and other symptoms in the neck and shoulders. Missing this diagnosis could lead to prolonged pain and potential neurological deficits.
  • Polymyalgia Rheumatica: An inflammatory condition that causes muscle pain and stiffness, typically in the shoulders and hips. Although less likely given the absence of systemic symptoms, it's a diagnosis that should not be missed due to its potential for significant morbidity if left untreated.

• Rare Diagnoses

  • Fibromyalgia: A long-term condition characterized by widespread pain in the muscles and bones, areas of tenderness, and general fatigue. While it's less likely given the localized nature of the pain, fibromyalgia can sometimes present with predominant shoulder pain.
  • Neoplastic Processes: Rarely, shoulder pain can be the presenting symptom of a neoplastic process, such as a tumor affecting the nerves, bones, or soft tissues of the shoulder region. This would be an uncommon cause of bilateral trapezius muscle pain but is included for completeness.