Differential Diagnosis for Right Shoulder Pain
The patient presents with acute right shoulder pain after lifting a heavy grocery bag, which suggests a musculoskeletal injury. The following differential diagnoses are considered:
- Single most likely diagnosis
- Muscle Strain: The patient's history of lifting a heavy object and the sudden onset of sharp pain in the right upper back, along with tenderness in the subscapular region, are consistent with a muscle strain. The fact that she has full range of motion and strength in the right shoulder suggests that the injury is likely to the muscles or tendons rather than a more severe joint or bone injury.
- Other Likely diagnoses
- Rotator Cuff Strain: Given the mechanism of injury and the location of pain, a rotator cuff strain is a possible diagnosis. However, the presence of full range of motion and strength makes this less likely than a simple muscle strain.
- Thoracic Outlet Syndrome: The patient's symptoms could be consistent with thoracic outlet syndrome, especially given the sharp pain shooting through the right upper back. However, this diagnosis would typically be associated with more neurological symptoms, such as numbness or tingling, which are not mentioned.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism: Although the patient denies any recent surgery, fever, or other typical risk factors for pulmonary embolism, it is essential to consider this diagnosis due to its high mortality rate. The sharp pain in the upper back could be referred pain from a pulmonary embolism.
- Aortic Dissection: This is a rare but life-threatening condition that could present with sudden, severe back pain. Although the patient's history and physical exam do not strongly suggest this diagnosis, it is crucial to consider it due to its high mortality rate.
- Rare diagnoses
- Scapular Fracture: Although the patient denies any fall, a scapular fracture could occur from a severe muscle contraction or indirect trauma. This diagnosis would typically be associated with more significant trauma or a history of osteoporosis.
- Pancoast Tumor: A Pancoast tumor is a rare type of lung cancer that can cause shoulder pain due to invasion of the brachial plexus. This diagnosis would typically be associated with more systemic symptoms, such as weight loss or cough, which are not mentioned.