Differential Diagnosis for Shoulder Pain
The patient presents with shoulder pain when raising the arm, a symptom that has persisted since 2020. Considering the chronic nature of the pain and the specific action that triggers it, the following differential diagnoses are proposed:
Single Most Likely Diagnosis
- Subacromial Impingement Syndrome: This condition is characterized by the inflammation of the tendons of the rotator cuff as they pass under the acromion, leading to pain when the arm is raised. The chronic nature of the pain and its association with arm movement make this a highly plausible diagnosis.
Other Likely Diagnoses
- Rotator Cuff Tendinopathy: Wear and tear on the tendons of the rotator cuff can cause pain, especially with movements like raising the arm. Given the duration of the symptoms, tendinopathy is a likely consideration.
- Adhesive Capsulitis (Frozen Shoulder): Although typically associated with a more significant restriction in range of motion, early stages of frozen shoulder could present with pain on movement, making it a possible diagnosis.
- Bursitis: Inflammation of the bursae around the shoulder joint can cause pain, especially with specific movements like raising the arm.
Do Not Miss Diagnoses
- Fracture or Osteonecrosis: Although less likely given the chronic nature of the pain, it's crucial not to miss a fracture or osteonecrosis (e.g., of the humeral head), as these conditions require prompt treatment to prevent long-term damage.
- Infection or Septic Arthritis: While rare, infection within the shoulder joint is a medical emergency that could present with pain on movement, among other symptoms.
- Tumor: Both benign and malignant tumors can cause chronic pain and should be considered, especially if there's a significant change in the nature of the pain or if other systemic symptoms are present.
Rare Diagnoses
- Polymyalgia Rheumatica: An inflammatory condition that can cause shoulder pain, typically in older adults, and is often associated with stiffness and pain in other parts of the body.
- Referred Pain from the Cervical Spine: In some cases, pain from the cervical spine can be referred to the shoulder, especially if there's underlying cervical spondylosis or a herniated disc.
- Neurological Conditions: Certain neurological conditions, such as brachial plexopathy or peripheral neuropathy, can cause shoulder pain, although these would typically be accompanied by other neurological symptoms.