Differential Diagnosis for Right Shoulder Pain
The patient's presentation of right shoulder pain after a traumatic event, specifically hearing an audible pop while cleaning a glass door with her arm raised, suggests a mechanical injury to the shoulder. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Rotator Cuff Tear: The mechanism of injury, involving an audible pop while the arm was raised and moving in a circular motion, is highly suggestive of a rotator cuff tear. This type of injury is common in individuals who perform repetitive overhead motions or experience acute trauma to the shoulder.
Other Likely diagnoses
- Shoulder Impingement Syndrome: This condition, where the rotator cuff tendons are compressed during shoulder movements, could be exacerbated by the described activity and might present similarly, although the audible pop is more indicative of a tear.
- Labral Tear: A tear in the labrum, the cartilage surrounding the socket of the shoulder joint, could occur from the same mechanism, especially if the arm was forcefully rotated or pulled.
- Biceps Tendon Injury: The biceps tendon could be injured in a similar fashion, especially if the mechanism involved a significant forceful contraction or stretch of the biceps muscle.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Axillary Artery or Brachial Plexus Injury: Although less common, a severe injury could potentially damage the axillary artery or the brachial plexus, leading to serious complications such as significant bleeding, nerve damage, or even limb ischemia.
- Proximal Humerus Fracture: A fracture of the proximal humerus could occur from a fall or direct blow to the shoulder and might not always present with an obvious deformity, especially in the early stages.
Rare diagnoses
- Osteonecrosis of the Humeral Head: This condition, involving the death of bone tissue due to a lack of blood supply, could potentially be triggered by a traumatic event but is less common and might not present immediately.
- Glenohumeral Joint Dislocation: Although possible, a dislocation would typically present with more pronounced deformity and instability of the shoulder joint, which is not explicitly mentioned in the scenario provided.