Differential Diagnosis for 60F with Intermittent Intense Left Inferior Scapular Pain
- Single Most Likely Diagnosis
- Musculoskeletal strain or sprain: This is often the most common cause of scapular pain due to overuse, poor posture, or direct trauma to the area. The intermittent nature of the pain and its location suggest a mechanical issue that could be related to muscle or ligament strain.
- Other Likely Diagnoses
- Costochondritis or Tietze's syndrome: Inflammation of the cartilage that connects the ribs to the sternum can cause sharp pains that might radiate to the back, including the scapular area.
- 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 pain in the shoulder and scapular area, especially if the compression affects the lower nerves.
- Scoliosis or spinal degeneration: Abnormal curvature of the spine or degenerative changes can lead to uneven wear and tear on the muscles and joints of the back, potentially causing scapular pain.
- Do Not Miss Diagnoses
- Pulmonary embolism: Although less likely, a pulmonary embolism can cause sudden, severe chest pain that might radiate to the back, including the scapular area. This is a medical emergency.
- Aortic dissection: A tear in the inner layer of the aorta can cause severe, tearing chest pain that can radiate to the back. This condition is life-threatening and requires immediate medical attention.
- Pneumothorax: Air in the pleural space can cause sudden chest pain and shortness of breath. The pain can be sharp and might be referred to the scapular area.
- Rare Diagnoses
- Pancoast tumor: A type of lung cancer located at the top of the lung can cause shoulder and scapular pain due to invasion of the brachial plexus or ribs.
- Osteoid osteoma or other bone tumors: Although rare, benign or malignant bone tumors can cause nocturnal pain that is relieved by NSAIDs, and the location could potentially involve the scapula.
- Referred pain from abdominal organs: Certain conditions affecting abdominal organs like the spleen (e.g., splenic infarction) or pancreas can cause referred pain to the back, including the scapular area, due to shared nerve roots.