Differential Diagnosis for 81-year-old Male with Shoulder Pain
Single Most Likely Diagnosis
- Polymyalgia Rheumatica (PMR): Given the patient's age, elevated CRP, and shoulder pain, PMR is a strong consideration. The condition is characterized by inflammatory pain and stiffness in the shoulders, neck, and hips, often accompanied by elevated inflammatory markers like CRP.
Other Likely Diagnoses
- Osteoarthritis: A common condition in the elderly, osteoarthritis could explain the shoulder pain, although the elevated CRP might suggest an inflammatory component not typically seen in osteoarthritis.
- Rotator Cuff Tendinitis or Tear: Common in older adults, this condition could cause shoulder pain. However, it might not fully account for the significantly elevated CRP.
- Giant Cell Arteritis (GCA): While GCA is closely related to PMR and could explain the elevated CRP, it typically presents with headache, jaw claudication, and visual symptoms, which are not mentioned here.
Do Not Miss Diagnoses
- Septic Arthritis or Osteomyelitis: Although less likely given the information, an infectious process could cause shoulder pain and elevated CRP. Missing this diagnosis could lead to severe consequences, including joint destruction or sepsis.
- Malignancy (e.g., Metastatic Bone Disease): Cancer can cause bone pain and elevated inflammatory markers. It's crucial not to miss this diagnosis, as it would significantly alter management and prognosis.
- Fracture: Especially in an elderly patient, a fracture could be a cause of shoulder pain. An occult fracture might not be immediately apparent and could have serious implications if not addressed.
Rare Diagnoses
- Hematologic Disorders (e.g., Myeloproliferative Neoplasms): The slightly elevated MCV and hemoglobin could suggest a myeloproliferative disorder, although this would be less common and not directly related to the shoulder pain.
- Amyloidosis: A rare condition that can cause shoulder pain due to amyloid deposits in the joints or bones, but it would be an unusual presentation and not as likely given the other findings.
- Sarcoidosis: Although sarcoidosis can cause joint pain and elevated inflammatory markers, it would be less common in this age group and not as directly linked to the specific symptoms described.