Differential Diagnosis for Neck Pain
The patient presents with pain at the base of the neck, exacerbated by turning to the right and looking down, with occasional radiation to the left arm and upper back. Considering the history of AC separation, the following differential diagnoses are proposed:
- Single most likely diagnosis
- Cervical strain or sprain: The patient's symptoms of neck pain, exacerbated by movement, and the history of trauma (AC separation) suggest a musculoskeletal origin, making cervical strain or sprain the most likely diagnosis.
- Other Likely diagnoses
- Cervical disc herniation: The radiation of pain to the left arm and upper back could indicate a cervical disc herniation, which may be causing nerve root compression.
- Thoracic outlet syndrome: The patient's symptoms of pain in the left arm and upper back could also be consistent with thoracic outlet syndrome, particularly if there is compression of the brachial plexus or subclavian artery.
- Degenerative cervical spondylosis: The patient's age and symptoms of neck pain, exacerbated by movement, could also suggest degenerative cervical spondylosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cervical spine fracture: Although less likely, a cervical spine fracture could present with similar symptoms and would be a medical emergency.
- Spinal cord compression: Compression of the spinal cord could present with neck pain, weakness, and numbness in the arms or legs, and would require urgent attention.
- Vertebral artery dissection: A vertebral artery dissection could present with neck pain and neurological symptoms, and would be a medical emergency.
- Rare diagnoses
- Rheumatoid arthritis: Although less common, rheumatoid arthritis could present with neck pain and stiffness, particularly if there is involvement of the cervical spine.
- Osteomyelitis or discitis: Infection of the cervical spine could present with neck pain, fever, and neurological symptoms, although this would be a rare diagnosis.
- Tumor: A tumor of the cervical spine could present with neck pain, weakness, and numbness in the arms or legs, although this would be a rare diagnosis.