Differential Diagnosis for Pain in the Shoulder and Neck

• Single most likely diagnosis:
  • Musculoskeletal strain: This is often the most common cause of shoulder and neck pain, resulting from overuse, poor posture, or direct injury to the muscles and ligaments in the area.
• Other Likely diagnoses:
  • Tendinitis: Inflammation of the tendons, which connect muscles to bones, can cause pain in the shoulder and neck, especially with movement.
  • Bursitis: Inflammation of the bursae, fluid-filled sacs that cushion bones, tendons, and muscles near joints, can also lead to pain in these areas.
  • Herniated cervical disc: A condition where the disc between the vertebrae in the neck slips out, potentially pressing on nerves and causing pain.
  • Osteoarthritis: Wear and tear on the joints can lead to pain and stiffness in the neck and shoulder.
• Do Not Miss diagnoses:
  • Myocardial infarction (heart attack): Though less common, shoulder and neck pain can be referred pain from a heart attack, especially in women.
  • Pulmonary embolism: In rare cases, pain in the shoulder and neck can be associated with a blood clot in the lungs.
  • Stroke or transient ischemic attack (TIA): Sudden onset of neck pain, especially if accompanied by other neurological symptoms, could indicate a stroke or TIA.
• Rare diagnoses:
  • Thoracic outlet syndrome: Compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib) can cause neck and shoulder pain.
  • Polymyalgia rheumatica: An inflammatory disorder that causes muscle pain and stiffness, typically in the neck, shoulder, and hip areas.
  • Fibromyalgia: A long-term condition characterized by widespread pain in the muscles and bones, fatigue, and areas of tenderness.

Each of these diagnoses has a distinct set of symptoms and risk factors, and a thorough medical evaluation is necessary to determine the underlying cause of the pain.