Differential Diagnosis for Trapezius Myofascial Pain vs. Cervical Radiculopathy
Single Most Likely Diagnosis
- Trapezius Myofascial Pain: This is the most likely diagnosis if the patient presents with localized pain and tenderness in the trapezius muscle, especially if triggered by specific movements or palpation of trigger points. The pain typically does not radiate down the arm in a dermatomal pattern.
Other Likely Diagnoses
- Cervical Radiculopathy: This diagnosis should be considered if the patient reports pain radiating down the arm in a specific dermatomal distribution, accompanied by numbness, tingling, or weakness. Clinical findings may include decreased reflexes and muscle strength in the affected limb.
- Cervical Spondylosis: This condition involves wear and tear on the cervical spine and can cause both localized neck pain and radiculopathy symptoms if nerve roots are compressed.
- 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). Symptoms can include pain, numbness, and tingling in the neck and arm.
Do Not Miss Diagnoses
- Cervical Spinal Stenosis: A condition where the spinal canal narrows, potentially causing compression of the spinal cord. This can lead to serious neurological deficits if not addressed promptly.
- Disc Herniation: A herniated disc in the cervical spine can compress nerve roots or the spinal cord, leading to significant pain and neurological symptoms.
- Infections (e.g., Osteomyelitis, Discitis): Infections of the spine can cause severe pain and neurological deficits. Although less common, these conditions require urgent medical attention.
- Tumors: Both primary and metastatic tumors can affect the cervical spine, causing pain and neurological symptoms.
Rare Diagnoses
- Polymyalgia Rheumatica: An inflammatory condition that causes muscle pain and stiffness, particularly in the shoulders and hips. While not primarily a cervical spine condition, it can cause significant discomfort in the neck and shoulder region.
- Fibromyalgia: A chronic condition characterized by widespread muscle pain, fatigue, and tender points. The diagnosis is based on clinical criteria and can sometimes be considered in the differential for chronic neck and shoulder pain.
- Neurological Conditions (e.g., Multiple Sclerosis, Amyotrophic Lateral Sclerosis): These conditions can present with a wide range of neurological symptoms, including pain and weakness. They are less common but important to consider in the differential diagnosis of cervical radiculopathy and myofascial pain.