Differential Diagnosis for Shoulder Pain
The patient presents with severe shoulder pain, limited arm mobility, and difficulty sleeping, which has worsened since initial X-rays. Considering these symptoms, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Rotator Cuff Tear or Tendinitis: This condition is a common cause of shoulder pain, especially in individuals who have experienced trauma or have a history of repetitive arm movements. The worsening of symptoms since the X-rays and the significant limitation in arm use suggest a possible tear or severe tendinitis, which may not have been evident or has progressed since the initial imaging.
Other Likely Diagnoses
- Adhesive Capsulitis (Frozen Shoulder): Characterized by stiffness and pain in the shoulder joint, adhesive capsulitis can severely limit arm mobility and cause significant discomfort, aligning with the patient's symptoms.
- Osteoarthritis: Although less common in a 46-year-old, osteoarthritis of the shoulder can cause pain and limited mobility, especially if there's a history of trauma or repetitive strain.
- Bursitis: Inflammation of the bursae in the shoulder can cause pain and limit movement, potentially worsening over time if not addressed.
Do Not Miss Diagnoses
- Fracture: Although the patient mentions X-rays were done, it's crucial to ensure that no fracture was missed, especially if the patient has experienced trauma. Some fractures might not be immediately visible on initial X-rays.
- Infection (Septic Arthritis): Shoulder joint infection is a medical emergency that requires prompt treatment. Symptoms can include severe pain, limited mobility, and systemic signs of infection.
- Tumor: Both benign and malignant tumors can cause shoulder pain and limited mobility. Although rare, missing a diagnosis of a tumor could have significant consequences.
Rare Diagnoses
- Avascular Necrosis: A condition where the blood supply to the bone tissue is disrupted, leading to bone death. It's less common but can occur in the shoulder, especially with a history of trauma or steroid use.
- Brachial Plexus Injury: An injury to the nerves that conduct signals from the spinal cord to the shoulder and arm, which can cause severe pain, numbness, and limited mobility.
- Referred Pain from Other Sources: Sometimes, shoulder pain can be referred from other areas, such as the neck (cervical spine) or even internal organs like the gallbladder or heart. Although less likely, these sources should be considered if other diagnoses are ruled out.