Differential Diagnosis for R Shoulder Pain
The patient presents with right shoulder pain when raising the arm above the head and bringing it back, with a positive Neer and Hawkins test. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Subacromial Impingement Syndrome: This condition is the most likely diagnosis given the patient's symptoms and positive Neer and Hawkins tests. These tests are specifically designed to assess for subacromial impingement, which occurs when the tendons of the rotator cuff are compressed between the humeral head and the acromion, leading to pain when the arm is raised.
Other Likely Diagnoses
- Rotator Cuff Tendinopathy: This condition involves inflammation or degeneration of the rotator cuff tendons and can cause similar symptoms to subacromial impingement syndrome, including pain when raising the arm.
- Adhesive Capsulitis (Frozen Shoulder): Although it typically presents with more restricted range of motion and pain at the shoulder, it could be considered in the differential, especially if the patient has a history of trauma or diabetes.
- Labral Tears: Tears in the labrum, the cartilage that surrounds the socket of the shoulder joint, can cause pain, especially with movements that involve raising the arm and bringing it back.
Do Not Miss Diagnoses
- Fracture: Although less likely, a fracture (e.g., humeral head or scapular fracture) could present with acute onset of pain, especially after trauma. Missing a fracture could lead to significant morbidity if not promptly treated.
- Infection (Septic Arthritis or Osteomyelitis): Infections in the shoulder joint or bone can cause severe pain and have serious consequences if not treated promptly with antibiotics.
- Tumor: Both benign and malignant tumors can cause shoulder pain and must be considered, especially in the absence of a clear traumatic or overuse history.
Rare Diagnoses
- Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause shoulder pain but is less common and typically presents with additional symptoms like numbness or tingling in the arm.
- Scapulothoracic Bursitis: Inflammation of the bursae located between the scapula and the thoracic wall can cause pain, especially with movements of the scapula, but it is less commonly associated with the specific movements described.