Differential Diagnosis for 82 year old hypertensive female with right lateral shoulder pain radiating down the fingers
- Single most likely diagnosis
- Cervical Radiculopathy: This condition is characterized by pain radiating from the neck down to the arm and fingers, often due to nerve root compression. Given the patient's age and the nature of the pain, this is a highly plausible diagnosis. Hypertension can also contribute to vascular changes that might exacerbate radiculopathy symptoms.
- Other Likely diagnoses
- Rotator Cuff Tendinitis or Tear: While this typically presents with more localized shoulder pain, it can sometimes radiate down the arm, especially if there is associated bursitis or if the tear affects the supraspinatus tendon, which can cause referred pain.
- Brachial Plexus Neuropathy: This condition involves damage to the network of nerves that conducts signals from the spinal cord to the shoulder, arm, and hand. It could cause pain and numbness in the arm and fingers.
- Thoracic Outlet Syndrome: This 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 your shoulders and neck and numbness in your fingers.
- Do Not Miss diagnoses
- Myocardial Infarction (MI): Although less common, it's crucial to consider cardiac causes of arm pain, especially in a hypertensive patient. The pain of an MI can radiate to the arm.
- Pulmonary Embolism: While typically presenting with respiratory symptoms, in some cases, especially if the embolism is small, it might cause referred pain to the shoulder or arm.
- Aortic Dissection: This is a serious condition where there is a tear in the aorta's inner layer. It can cause severe, tearing pain that radiates to the back or down the arm.
- Rare diagnoses
- Pancoast Tumor: A type of lung cancer located at the top of the lung that can cause shoulder pain radiating down the arm due to invasion of the brachial plexus.
- Multiple Myeloma: A type of blood cancer that can cause bone pain, including in the shoulder and arm, due to bone lesions.
- Amyloidosis: A condition caused by an abnormal protein (amyloid) that can accumulate in various organs, including nerves, leading to neuropathic pain.