Differential Diagnoses for Shoulder Pain
The differential diagnoses for shoulder pain can be categorized into the following groups:
- Single Most Likely Diagnosis
- Rotator cuff tendinitis: This is the most common cause of shoulder pain, often resulting from overuse or repetitive strain on the rotator cuff muscles and tendons.
- Other Likely Diagnoses
- Adhesive capsulitis (frozen shoulder): Characterized by stiffness and limited range of motion in the shoulder joint, often following trauma or inflammation.
- Bursitis: Inflammation of the bursae, fluid-filled sacs that cushion the joints, can cause pain and swelling in the shoulder.
- Labral tears: Tears in the labrum, a cartilaginous structure surrounding the socket of the shoulder joint, can cause pain and instability.
- Osteoarthritis: Wear and tear on the joint cartilage can lead to pain, stiffness, and limited mobility in the shoulder.
- Do Not Miss Diagnoses
- Pulmonary embolism: Referred pain from a pulmonary embolism can manifest as shoulder pain, making it a critical diagnosis not to miss.
- Myocardial infarction: Referred pain from a heart attack can also present as shoulder pain, particularly on the left side.
- Spinal cord injury or compression: Compression or injury to the spinal cord can cause radiating pain to the shoulder, which requires prompt attention.
- Septic arthritis: Bacterial infection of the joint can cause severe pain, swelling, and limited mobility, requiring urgent medical attention.
- Rare Diagnoses
- Avascular necrosis: Loss of blood supply to the bone tissue can cause pain and collapse of the bone, particularly in the humeral head.
- Pancoast tumor: A rare type of lung cancer that can cause shoulder pain due to invasion of the brachial plexus or adjacent structures.
- Polymyalgia rheumatica: An inflammatory condition that can cause pain and stiffness in the shoulders, often accompanied by other systemic symptoms.
- Sickle cell disease: A genetic disorder that can cause vaso-occlusive crises, leading to pain and swelling in the shoulders and other joints.