Differential Diagnosis for Shoulder and Back Pain
The following differential diagnoses are organized into categories to help guide the diagnostic process.
- Single Most Likely Diagnosis
- Musculoskeletal strain: This is the most common cause of shoulder and back pain, often resulting from overuse, poor posture, or acute injury. Justification: High prevalence and common presentation in clinical practice.
- Other Likely Diagnoses
- Herniated disc: Can cause radiating pain, numbness, and weakness in the back and shoulder region due to nerve compression. Justification: Common condition that can cause significant pain and neurological symptoms.
- Osteoarthritis: Wear and tear of the joints can lead to pain and stiffness in the shoulders and back. Justification: Common in older adults and those with a history of joint disease.
- Tendinitis or bursitis: Inflammation of the tendons or bursae can cause localized pain and stiffness. Justification: Common overuse injuries in individuals who engage in repetitive activities.
- Fibromyalgia: A chronic condition characterized by widespread muscle pain, fatigue, and tender points. Justification: Can present with shoulder and back pain, although diagnosis requires a broader pattern of symptoms.
- Do Not Miss Diagnoses
- Myocardial infarction (MI): Chest pain can radiate to the back and shoulder, making it essential to consider cardiac causes, especially in individuals with risk factors. Justification: Potentially life-threatening if missed.
- Pulmonary embolism (PE): Can cause sudden onset of back and shoulder pain, often accompanied by respiratory symptoms. Justification: High mortality rate if not promptly diagnosed and treated.
- Aortic dissection: Severe, tearing chest pain that can radiate to the back and shoulder, requiring immediate medical attention. Justification: Life-threatening condition with high mortality if not promptly treated.
- Spinal cord compression: Can result from trauma, infection, or tumors, leading to neurological deficits and pain. Justification: Requires urgent intervention to prevent permanent damage.
- Rare Diagnoses
- Pancoast tumor: A type of lung cancer that can cause shoulder and back pain due to invasion of nearby structures. Justification: Rare but important to consider in smokers or those with a history of cancer.
- Multiple myeloma: A plasma cell disorder that can cause bone pain, including in the shoulders and back. Justification: Rare but potentially treatable with early diagnosis.
- Polymyalgia rheumatica: An inflammatory condition that causes muscle pain and stiffness, often in the shoulders and back. Justification: Less common but can be treated effectively with corticosteroids.
- Spondyloarthritis: A group of inflammatory diseases that can cause back and shoulder pain, among other symptoms. Justification: Important to consider in individuals with a family history or other suggestive symptoms.