Differential Diagnosis for a 30-year-old Female Patient with Neck and Shoulder Pain
Based on the provided subjective and follow-up questions, the differential diagnosis for this patient can be categorized as follows:
- Single most likely diagnosis
- Muscle Strain: The patient's history of turning her neck to the left for too long during a stretch and the subsequent onset of neck and shoulder pain suggests a muscle strain. The improvement with muscle relaxers and the localized nature of the pain also support this diagnosis.
- Other Likely diagnoses
- Cervical Facet Joint Pain: The patient's pain is exacerbated by movement, particularly when turning her head up or getting out of bed, which could indicate facet joint involvement.
- Cervical Disc Herniation: Although the patient does not have radiating arm pain, the numbness in her hand on the first day of pain could be a sign of a disc herniation. However, this is less likely given the absence of persistent radicular symptoms.
- Thoracic Outlet Syndrome: The patient's pain is localized to the neck and right shoulder, and she experienced numbness in her hand, which could be indicative of thoracic outlet syndrome. However, this diagnosis would typically require more specific symptoms such as arm pain or paresthesias.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Cervical Spine Fracture: Although the patient had a normal CT scan after a car accident a year ago, it is essential to consider the possibility of a new or missed fracture, particularly given her history of trauma.
- Spinal Epidural Abscess: This is a rare but potentially life-threatening condition that can present with neck pain and stiffness. Although unlikely, it is crucial to consider this diagnosis, especially if the patient's symptoms worsen or do not respond to treatment.
- Cervical Spinal Cord Injury: Given the patient's history of a concussion and car accident, it is essential to rule out a spinal cord injury, which could have been missed or developed later.
- Rare diagnoses
- Rheumatological Disorders (e.g., Rheumatoid Arthritis, Ankylosing Spondylitis): These conditions can present with neck and shoulder pain, but they are less likely in this patient given her age, lack of systemic symptoms, and absence of other joint involvement.
- Infectious or Inflammatory Conditions (e.g., Osteomyelitis, Discitis): These conditions are rare and typically present with more systemic symptoms, such as fever or weight loss, which are not mentioned in the patient's history.