Differential Diagnosis for Right Shoulder Pain
The patient's symptoms of a 'dead ache' in the deltoid region, radiating pain, and limited mobility suggest a range of possible diagnoses. Here is a categorized differential diagnosis:
Single most likely diagnosis
- Subacromial Impingement Syndrome: This condition is characterized by pain in the deltoid region, a painful arc with arm lifting, and difficulty with certain movements, all of which match the patient's symptoms. The improvement with NSAIDs (Advil) also supports this diagnosis, as it is often responsive to anti-inflammatory medication.
Other Likely diagnoses
- Rotator Cuff Tendinopathy: Given the patient's age and the nature of the pain, rotator cuff tendinopathy is a plausible diagnosis. The pain pattern and the specific activities that exacerbate the pain, such as lifting and certain movements, are consistent with this condition.
- Adhesive Capsulitis (Frozen Shoulder): Although the patient can still move his arm, the pain and limited mobility, especially with specific movements like shaving the back of his neck, could suggest early stages of adhesive capsulitis. However, the absence of more significant restriction in passive movement makes this less likely.
- Bursitis: Inflammation of the bursae around the shoulder joint could cause pain in the deltoid region and limit movement, especially with activities that involve lifting or reaching.
Do Not Miss diagnoses
- Cervical Radiculopathy: Although the patient mentions the pain occasionally radiates into the hand, the absence of specific finger involvement and the nature of the pain make this less likely. However, missing a cervical radiculopathy could lead to delayed diagnosis and potentially permanent neurological damage, making it a "do not miss" diagnosis.
- Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It could cause pain in the shoulder and arm but is less likely given the specific pattern of pain and activities that exacerbate it.
- Referred Pain from Cardiac or Pulmonary Issues: Although rare, shoulder pain can be referred from cardiac (e.g., myocardial infarction) or pulmonary (e.g., pulmonary embolism) issues. These are critical conditions that require immediate attention, making them "do not miss" diagnoses.
Rare diagnoses
- Osteonecrosis of the Humeral Head: This condition involves the death of bone tissue in the humeral head due to lack of blood supply. It's less common and typically associated with specific risk factors (e.g., long-term steroid use, excessive alcohol consumption), but it could cause shoulder pain.
- Infectious or Inflammatory Arthritis: Conditions like septic arthritis or rheumatoid arthritis could cause shoulder pain but are less likely given the patient's presentation and the absence of systemic symptoms or other joint involvement.
- Tumors: Both benign and malignant tumors could cause shoulder pain, but they are rare and usually present with additional symptoms such as a palpable mass, significant weight loss, or night pain.