Differential Diagnosis for 17-year-old with Right Shoulder Pain
- Single most likely diagnosis:
- Subacromial Bursitis or Rotator Cuff Tendinitis: The patient's symptoms of shoulder pain worsening with movement, and the location of the pain (lateral/posterior shoulder), are consistent with subacromial bursitis or rotator cuff tendinitis. Her occupation as a ride operator and participation in lacrosse could contribute to repetitive strain injuries.
- Other Likely diagnoses:
- Shoulder Impingement Syndrome: Similar to subacromial bursitis, this condition involves the compression of the rotator cuff tendons and/or bursa between the humeral head and the acromion, leading to pain and limited mobility.
- Labral Tear or SLAP Lesion: The patient's history of lacrosse, a sport that involves throwing and potential falls, increases the risk for labral tears or SLAP (Superior Labrum Anterior to Posterior) lesions, which could cause shoulder pain.
- Adhesive Capsulitis (Frozen Shoulder): Although less common in younger individuals, adhesive capsulitis could be considered, especially if the patient has had a recent decrease in activity or an injury that led to prolonged immobilization of the shoulder.
- Do Not Miss diagnoses:
- Septic Arthritis or Osteomyelitis: Although the patient is afebrile, it's crucial to consider infectious causes, especially if there's any history of recent infection, IV drug use, or immunocompromised state. These conditions require prompt diagnosis and treatment to prevent long-term damage.
- Fracture: Despite the denial of specific injury or trauma, it's essential to consider the possibility of a fracture, particularly a stress fracture, given the patient's athletic activities.
- Rare diagnoses:
- Osteonecrosis (Avascular Necrosis): This condition, although rare, could be considered in the differential diagnosis, especially if the patient has a history of steroid use or other risk factors.
- Tumors (e.g., Osteoid Osteoma, Ewing's Sarcoma): Although extremely rare, bone tumors could present with localized pain and should be considered if other diagnoses are ruled out and pain persists or worsens over time.