Differential Diagnosis for Posterior Shoulder and Upper Back Pain
- Single most likely diagnosis
- Musculoskeletal strain: The patient's symptoms of posterior shoulder and upper back pain after shoveling, followed by numbness down the hand, are consistent with a musculoskeletal strain. The recent physical activity of shoveling is a common cause of strain in the shoulder and back muscles. The numbness down the hand could be referred pain from the strained muscles.
- Other Likely diagnoses
- Cervical radiculopathy: The patient's symptoms of numbness down the hand could be indicative of cervical radiculopathy, which is a common condition that causes pain and numbness in the neck, shoulder, and arm. The recent physical activity of shoveling could have exacerbated a pre-existing condition.
- Thoracic outlet syndrome: This condition occurs when the nerves and blood vessels in the thoracic outlet (the space between the collarbone and first rib) are compressed, causing pain and numbness in the shoulder, arm, and hand. The patient's symptoms and recent physical activity make this a possible diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although less likely, pulmonary embolism is a life-threatening condition that can cause sudden onset of shoulder and back pain. The patient's recent physical activity could be a risk factor, and it is essential to consider this diagnosis to avoid missing a potentially fatal condition.
- Aortic dissection: This is a rare but life-threatening condition that can cause sudden onset of severe back and shoulder pain. Although the patient's symptoms do not strongly suggest this diagnosis, it is essential to consider it to avoid missing a potentially fatal condition.
- Rare diagnoses
- Pancoast tumor: This is a rare type of lung cancer that can cause shoulder and back pain, as well as numbness in the arm and hand. Although the patient's symptoms do not strongly suggest this diagnosis, it is essential to consider it in the differential diagnosis.
- Spinal cord injury: This is a rare but serious condition that can cause numbness, weakness, and pain in the shoulder, arm, and hand. Although the patient's symptoms do not strongly suggest this diagnosis, it is essential to consider it in the differential diagnosis, especially given the recent physical activity.