Differential Diagnosis for 32-year-old Female with Episodes of Pain in Left Shoulder and Upper Back with Left Hand Numbness

• Single Most Likely Diagnosis
  • Cervical Radiculopathy: This condition, often resulting from a herniated disk or bone spur in the cervical spine, can cause pain in the shoulder and upper back that radiates down to the arm or hand, leading to numbness. The symptoms described are classic for compression of a cervical nerve root, which could be C5, C6, or C7, depending on the specific distribution of pain and numbness.
• Other Likely Diagnoses
  • Thoracic Outlet Syndrome (TOS): This condition involves compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the thoracic outlet area, which lies between your collarbone (clavicle) and first rib. It can cause pain in the shoulders and neck and numbness in the hands.
  • Fibromyalgia: Although fibromyalgia is characterized by widespread musculoskeletal pain, it can also cause localized pain and numbness, especially if the patient has tender points in the shoulder and upper back regions.
  • Myofascial Pain Syndrome: This condition involves pain and inflammation in specific muscle areas, which could explain the localized pain and potentially the numbness if the affected muscles are near nerves.
• Do Not Miss Diagnoses
  • Pancoast Tumor: A type of lung cancer located at the top of the lung that can cause shoulder and arm pain, as well as numbness, due to its invasion into nearby nerves.
  • Spinal Cord Injury or Compression: Conditions such as spinal stenosis, spinal tumors, or acute injuries can compress the spinal cord, leading to a range of symptoms including pain, numbness, and potentially more severe neurological deficits.
  • Vascular Conditions (e.g., Subclavian Artery Thrombosis or Embolism): These conditions can lead to decreased blood flow to the arm, resulting in pain and numbness.
• Rare Diagnoses
  • Multiple Sclerosis (MS): An autoimmune disease that affects the brain and spinal cord, leading to a wide range of neurological symptoms, including numbness and pain. Although MS can present with almost any neurological symptom, the specific pattern described would be less common.
  • Peripheral Neuropathy: Conditions affecting the peripheral nerves can cause numbness and pain but would typically have a more distal distribution (i.e., affecting the hands and feet more prominently).
  • Complex Regional Pain Syndrome (CRPS): A chronic pain condition characterized by severe, burning pain at the site of an injury, which can also cause numbness and changes in skin temperature and color.