What is the cause of neck pain radiating to bilateral shoulders and small bumps on the left palm after carpal tunnel surgery?

Differential Diagnosis

• Single Most Likely Diagnosis
  • Musculoskeletal strain (e.g., strain from sleeping wrong):
    • This diagnosis is likely due to the patient's report of sleeping wrong and the presence of pain in the neck and shoulders, which is a common presentation for musculoskeletal strain. The patient's attempt to alleviate the pain by changing pillows and using OTC ibuprofen also supports this diagnosis.
• Other Likely Diagnoses
  • Cervical spondylosis or cervical strain:
    • This diagnosis is possible due to the patient's age and the presence of pain in the neck and shoulders, which can be referred from the cervical spine.
  • Tension headache:
    • This diagnosis is possible due to the patient's report of mild headache and pain in the neck and shoulders, which can be associated with tension headaches.
  • Carpal tunnel syndrome (residual or recurrent):
    • This diagnosis is possible due to the patient's history of carpal tunnel surgery and the presence of small ball-like bumps on the left palm, which could be related to nerve damage or residual symptoms.
• Do Not Miss Diagnoses
  • Cervical spine fracture or injury:
    • This diagnosis is crucial to consider due to the potential for serious complications, such as spinal cord injury, if left undiagnosed or untreated.
  • Meningitis or encephalitis:
    • This diagnosis is important to consider due to the patient's report of headache, although the absence of fever, stiff neck, or other systemic symptoms makes it less likely.
  • Inflammatory arthritis (e.g., rheumatoid arthritis):
    • This diagnosis is important to consider due to the patient's report of small ball-like bumps on the left palm, which could be related to an inflammatory arthritis.
• Rare Diagnoses
  • Multiple sclerosis:
    • This diagnosis is possible but rare, and would require further evaluation and testing to confirm.
  • Neuroma or nerve tumor:
    • This diagnosis is possible but rare, and would require further evaluation and testing to confirm, particularly in the context of the patient's history of carpal tunnel surgery.
  • Sjögren's syndrome:
    • This diagnosis is possible but rare, and would require further evaluation and testing to confirm, particularly in the context of the patient's report of small ball-like bumps on the left palm.