Differential diagnosis of shoulder and cervical pain: a case report

Abstract

Patients are frequently referred to physical therapy with the diagnosis of shoulder and arm pain. During examination and evaluation of the patient, the physical therapist must consider all potential causes of the patient's symptoms. Three questions are used as the conceptual basis for a diagnosis-based clinical decision rule in the management of mechanical and non-mechanical musculoskeletal pain when addressing the differential diagnosis of a patient's condition. This single patient case report describes the use of these three questions in the differential diagnosis of shoulder and arm pain. A 44-year-old male was referred with a diagnosis of shoulder impingement syndrome. Each of the three questions for differential diagnosis was addressed, and clinical tests and examination findings were used to differentiate the origin of the patient's symptoms. The intervention provided is outlined along with the patient's response to the different treatment strategies provided. This case identifies the need for a systematic method of differential diagnosis so that patients are appropriately managed.

Keywords: Arm pain; Cervical radiculopathy; Differential diagnosis; Shoulder impingement.

Figure 1

Body chart of reported pain.

Figure 2

Sagital magnetic resonance imaging scan of the cervical spine. The image displays disruption at the C6 segment. There is also osteophyte lipping at the margins of the vertebral bodies above the C6 level.