Differential Diagnosis for 53-year-old Female with R Shoulder Pain
- Single most likely diagnosis
- Rotator cuff re-tear or failed repair: Given the patient's history of rotator cuff surgery, a re-tear or failed repair is a common complication that could lead to persistent or recurrent shoulder pain, especially with activities like lifting over her head.
- Other Likely diagnoses
- Adhesive capsulitis (frozen shoulder): This condition can cause significant pain and stiffness in the shoulder, making it difficult to lift the arm or sleep due to pain. It's a common condition that can occur after shoulder surgery or injury.
- Subacromial bursitis: Inflammation of the bursa under the acromion can cause anterior shoulder pain and tenderness, especially with movements that involve lifting the arm.
- Tendinitis of the remaining rotator cuff tendons: If the patient has had surgery on one part of the rotator cuff, other parts can still become inflamed or injured, leading to pain and dysfunction.
- Do Not Miss diagnoses
- Septic arthritis or osteomyelitis: Although less likely, these infections can occur post-surgically and would require urgent medical attention to prevent serious complications. Symptoms might include significant pain, redness, swelling, and warmth around the joint.
- Brachial plexus injury: Direct trauma or surgical complications could lead to a brachial plexus injury, which would cause significant pain, weakness, and potentially numbness or tingling in the arm.
- Rare diagnoses
- Avascular necrosis of the humeral head: This condition, where the blood supply to the bone is interrupted, can occur after trauma or certain medical conditions. It's less common but could be a consideration in the context of significant trauma or steroid use.
- Neuropathic pain syndromes (e.g., complex regional pain syndrome): These conditions are characterized by chronic pain that's out of proportion to the initial injury and can involve significant changes in skin temperature and color. They are less common but should be considered if other diagnoses are ruled out.