Differential Diagnosis for 18-year-old Baseball Player with 4 Weeks of Right Shoulder Pain
- Single most likely diagnosis:
- Subacromial Impingement Syndrome: This condition is common in overhead athletes like baseball players. The repetitive motion of throwing can lead to inflammation of the tendons and bursae in the shoulder, causing pain and limited mobility. The duration of symptoms and the patient's athletic activity support this diagnosis.
- Other Likely diagnoses:
- Rotator Cuff Tendinopathy: Similar to impingement syndrome, tendinopathy of the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) is common in athletes who perform repetitive throwing motions. This condition can cause pain, especially with abduction and external rotation of the arm.
- Labral Tear: The labrum is a cartilaginous structure surrounding the socket of the shoulder joint. Throwing athletes are at risk for labral tears, which can cause pain, especially with movements that involve abduction and external rotation.
- Scapular Dyskinesis: This condition involves abnormal movement patterns of the scapula, which can lead to shoulder pain and dysfunction. It's common in athletes who use repetitive overhead motions.
- Do Not Miss diagnoses:
- Osteonecrosis (Avascular Necrosis) of the Humeral Head: Although less common, osteonecrosis can occur in young athletes, especially if there's a history of trauma or steroid use. It's crucial to diagnose early to prevent collapse of the bone and severe arthritis.
- Infection (Septic Arthritis or Osteomyelitis): Infection in the shoulder joint or bone can present with pain and limited mobility. It's essential to consider this diagnosis, especially if there are systemic symptoms like fever or if the patient has recently traveled or been exposed to infectious diseases.
- Tumor: Although rare, bone or soft tissue tumors can cause shoulder pain. A thorough history and examination, along with appropriate imaging, are necessary to rule out this possibility.
- Rare diagnoses:
- Quadrilateral Space Syndrome: This condition involves compression of the axillary nerve and posterior circumflex humeral artery, causing pain and weakness in the shoulder. It's rare but can occur in athletes.
- Suprascapular Neuropathy: Compression of the suprascapular nerve can cause pain and weakness in the shoulder, particularly affecting the supraspinatus and infraspinatus muscles. It's less common but should be considered in athletes with persistent shoulder pain.