Differential Diagnosis

The patient's symptoms of difficulty wearing a bra, horizontal abduction on the affected limb, and issues with cooking and extension suggest a problem with the shoulder or upper limb. Here's a categorized differential diagnosis:

• Single most likely diagnosis

  • Adhesive Capsulitis (Frozen Shoulder): This condition is characterized by pain and stiffness in the shoulder joint, leading to limited mobility. The difficulty in wearing a bra and performing daily activities like cooking could be due to the restricted range of motion and pain associated with frozen shoulder.

• Other Likely diagnoses

  • Rotator Cuff Injury: Injuries to the rotator cuff muscles or tendons can cause pain and weakness in the shoulder, making it hard to perform overhead activities or movements that require abduction and extension.
  • Shoulder Impingement Syndrome: This condition occurs when the shoulder blade puts pressure on the underlying soft tissues when you lift your arm away from your body, which could explain the difficulty with horizontal abduction and other movements.
  • Osteoarthritis of the Shoulder: While less common than in other joints, osteoarthritis of the shoulder can cause pain and stiffness, leading to difficulties with movement.

• Do Not Miss diagnoses

  • Brachial Plexus Injury: Although less likely, an injury to the brachial plexus could cause significant morbidity if missed. It might result from trauma and could lead to weakness, numbness, and limited mobility in the affected arm.
  • Pancoast Tumor: A type of lung cancer located at the top of the lung, which can invade nearby structures including the brachial plexus and shoulder, causing pain and limited mobility of the arm.

• Rare diagnoses

  • Polymyalgia Rheumatica: An inflammatory condition that causes muscle pain and stiffness, particularly in the shoulders and hips. While it could contribute to the patient's symptoms, it's less directly related to the specific movements mentioned.
  • Sickle Cell Disease with Shoulder Involvement: In rare cases, sickle cell disease can cause avascular necrosis of the shoulder joint, leading to pain and limited mobility. However, this would be an uncommon presentation and typically associated with other systemic symptoms.