Differential Diagnosis for Shoulder Pain
Single most likely diagnosis
- Supraspinatus Tendinopathy: The patient's symptoms, including pain in the front of the shoulder that is tender to palpation, worsening with the empty can test, and exacerbation with overhead lifting, are classic for supraspinatus tendinopathy. The mechanism of injury, grabbing a pole with the arm after jumping off a fire truck, could have caused repetitive strain or an acute injury to the supraspinatus tendon.
Other Likely diagnoses
- Subacromial Bursitis: This condition can present with similar symptoms, including pain in the front of the shoulder and tenderness to palpation. The empty can test can also be positive in subacromial bursitis due to the proximity of the bursa to the supraspinatus tendon.
- Labral Tear: A labral tear, particularly in the superior labrum, could cause pain in the front of the shoulder and worsen with overhead activities. The mechanism of injury could have contributed to a labral tear.
- Rotator Cuff Strain: Given the acute onset after a traumatic event, a strain of the rotator cuff muscles, including the supraspinatus, could be considered. This would also explain the worsening of symptoms with the empty can test and overhead lifting.
Do Not Miss diagnoses
- Proximal Humerus Fracture: Although less likely given the duration of symptoms, a fracture of the proximal humerus could present with similar pain patterns and must be ruled out, especially in the context of a significant traumatic event.
- Axillary Nerve Injury: An injury to the axillary nerve could cause pain and weakness in the shoulder region. This is a critical diagnosis not to miss due to the potential for long-term sequelae if not properly addressed.
- Thoracic Outlet Syndrome: This condition involves compression of the neurovascular bundle and could present with shoulder pain, especially if there is a component of neurogenic thoracic outlet syndrome involving the brachial plexus.
Rare diagnoses
- Quadrilateral Space Syndrome: This is a rare condition involving compression of the axillary nerve and posterior circumflex humeral artery, which could present with shoulder pain and weakness.
- Osteonecrosis of the Humeral Head: Although rare, osteonecrosis could be a consideration, especially if there was a significant traumatic event leading to disruption of the blood supply to the humeral head.