Differential Diagnosis for Left Scapula Pain
Single Most Likely Diagnosis
- Muscle Strain: Given the history of a car wreck and the description of deep muscle pain, a muscle strain in the muscles surrounding the scapula (such as the trapezius, rhomboids, or levator scapulae) is the most plausible diagnosis. The trauma from the accident could have caused direct injury to these muscles.
Other Likely Diagnoses
- Rib Fracture: The pain could be referred from a fractured rib, which is a common injury in car accidents. The fracture could irritate the surrounding muscles and nerves, leading to pain in the scapular area.
- Scapulothoracic Bursitis: Inflammation of the bursae between the scapula and the thoracic wall could cause deep pain in the scapular region, especially if the patient has been using their arm in an abnormal way due to the accident.
- Thoracic Outlet Syndrome: This condition, involving compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib), could cause pain in the scapular area, especially if the patient's posture or movement patterns have changed following the accident.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less likely, a pulmonary embolism could cause referred pain to the scapula, especially if the patient has been immobile following the accident. This is a life-threatening condition that requires immediate medical attention.
- Myocardial Infarction: In rare cases, myocardial infarction (heart attack) can cause referred pain to the back, including the scapular area. Given the potential severity, it's crucial to consider this diagnosis, especially in patients with risk factors for cardiovascular disease.
- Spinal Injury: The car wreck could have caused a spinal injury (e.g., herniated disk, spinal fracture) that refers pain to the scapular area. Missing such an injury could lead to further neurological compromise.
Rare Diagnoses
- Tumor: A tumor in the scapula, ribs, or spine could cause deep, persistent pain. Although rare, it's an important consideration, especially if the pain is persistent and not responding to typical treatments for musculoskeletal injuries.
- Osteomyelitis: An infection of the bone could cause deep pain in the scapular area, although this would typically be accompanied by other symptoms such as fever, redness, and swelling.
- Pancoast Tumor: A rare type of lung cancer located at the top of the lung, which could cause shoulder and scapular pain due to local invasion of the surrounding structures.