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Differential Diagnosis for Unilateral Shoulder Pain in a 50-year-old Woman with Increased Pain at Night

Single Most Likely Diagnosis

  • Adhesive Capsulitis (Frozen Shoulder): This condition is common in middle-aged women and is characterized by pain and stiffness in the shoulder, often worsening at night. The pain is typically unilateral and can be severe enough to disrupt sleep.

Other Likely Diagnoses

  • Rotator Cuff Tendinitis: Inflammation of the tendons surrounding the shoulder joint can cause pain, especially at night when the shoulder is at rest. This condition is common in individuals who perform repetitive overhead activities.
  • Bursitis: Inflammation of the fluid-filled sacs (bursae) that cushion the joints can cause pain and stiffness, particularly if the bursae in the shoulder are affected.
  • Osteoarthritis: Although less common in the shoulder compared to other joints, osteoarthritis can cause pain that worsens at night due to the lack of movement and potential for joint stiffness.

Do Not Miss Diagnoses

  • Metastatic Bone Disease: While less likely, it is crucial not to miss metastatic disease to the bone, which can present with unilateral shoulder pain that worsens at night. Breast, lung, and prostate cancers are common sources of bone metastases.
  • Multiple Myeloma: A type of blood cancer that can cause bone pain, including in the shoulder, which may be worse at night.
  • Infection (Osteomyelitis or Septic Arthritis): Although rare, infections in the bone or joint can cause severe pain, redness, and swelling, and are medical emergencies.

Rare Diagnoses

  • Polymyalgia Rheumatica (PMR): An inflammatory condition that affects the muscles, leading to pain and stiffness, particularly in the shoulders. It is more common in older adults and can cause significant discomfort.
  • Avascular Necrosis of the Humeral Head: A condition where the blood supply to the bone tissue is interrupted, leading to bone death. It can cause severe shoulder pain, especially at night, and is often associated with long-term steroid use, excessive alcohol consumption, or traumatic injury.
  • Pancoast Tumor: A rare type of lung cancer located at the top of the lung that can cause shoulder pain due to local invasion of the surrounding structures, including the brachial plexus.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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