Differential Diagnosis for 90 yo Female with Right Shoulder Pain
- Single most likely diagnosis
- Osteoarthritis of the AC joint: This is the most likely diagnosis given the X-ray findings of moderate degenerative changes in the AC joint with hypertrophy of the capsule, which are characteristic of osteoarthritis. The patient's age and symptoms of shoulder pain also support this diagnosis.
- Other Likely diagnoses
- Rotator cuff tendinosis or tear: Although the X-ray does not specifically show rotator cuff pathology, rotator cuff disorders are common in elderly patients and can cause shoulder pain.
- Adhesive capsulitis (frozen shoulder): This condition can cause shoulder pain and stiffness, especially in older adults, and may be related to the hypertrophy of the capsule seen on X-ray.
- Bursitis: Inflammation of the bursae around the shoulder joint can cause pain and may be associated with degenerative changes in the AC joint.
- Do Not Miss diagnoses
- Fracture: Although the X-ray shows degenerative changes, it is essential to carefully evaluate the images for any signs of fracture, especially in an elderly patient who may have osteoporosis.
- Infection (septic arthritis): Infection in the joint can cause severe pain and may not always be apparent on initial X-ray. A high index of suspicion is necessary, especially if the patient has fever, redness, or swelling.
- Referred pain from cervical spine: Pain from the cervical spine can refer to the shoulder, and it is crucial to consider this possibility, especially if the patient has a history of neck pain or trauma.
- Rare diagnoses
- Rheumatoid arthritis: Although less likely, rheumatoid arthritis can cause shoulder pain and joint degeneration, and it is essential to consider this diagnosis, especially if the patient has a history of autoimmune disorders.
- Polymyalgia rheumatica: This condition can cause shoulder pain and stiffness, especially in older adults, and may be associated with inflammatory markers.
- Tumor: A tumor in the shoulder region can cause pain and degenerative changes, although this is a rare possibility.