Differential Diagnosis for Clavicular Pain with Radiation to Shoulder and Scapula
Single Most Likely Diagnosis
- Clavicle Fracture: The presence of clavicular pain, radiation to the shoulder and superior border of the scapula, difficulty with horizontal adduction, extension, and flexion, along with a bony prominence on the clavicle, strongly suggests a fracture of the clavicle. This is a common injury that can result from direct trauma to the clavicle or from a fall onto an outstretched hand.
Other Likely Diagnoses
- Acromioclavicular Joint Separation: This condition involves an injury to the ligaments that connect the acromion to the clavicle, leading to pain and instability in the shoulder region. It could present with similar symptoms, including pain and difficulty moving the affected limb.
- Clavicular Osteolysis: A condition characterized by the destruction of the distal end of the clavicle, often due to repetitive strain or trauma. It can cause pain in the clavicular region and affect shoulder movement.
- Scapulothoracic Bursitis: Inflammation of the bursa between the scapula and the thoracic wall can cause pain that radiates to the shoulder and scapula, and could potentially affect movement of the limb.
Do Not Miss Diagnoses
- Pancoast Tumor: A type of lung cancer located at the apex of the lung, which can cause shoulder and arm pain due to invasion of the brachial plexus and destruction of the surrounding bone, including the clavicle. Although rare, missing this diagnosis could have severe consequences.
- Osteomyelitis of the Clavicle: An infection of the bone that can cause pain, swelling, and redness over the affected area. It is less common but requires prompt treatment to avoid serious complications.
Rare Diagnoses
- Ewing's Sarcoma: A rare type of bone cancer that can affect any bone but is more common in the pelvis, femur, and humerus. It could potentially present with clavicular involvement, though this would be uncommon.
- Gorlin Syndrome (Nevoid Basal Cell Carcinoma Syndrome): A rare genetic disorder that can include multiple basal cell carcinomas, jaw cysts, and bone abnormalities, including bifid ribs and vertebrae, but clavicular abnormalities are less commonly highlighted.
- Cleidocranial Dysplasia: A rare genetic condition affecting the development of bones and teeth, characterized by the partial or complete absence of the clavicles, among other features. While it's a congenital condition, it might not be diagnosed until later in life if mild.