Differential Diagnosis for Shoulder Pain in Young Adults

Primary Differential Diagnoses

• The American Academy of Orthopaedic Surgeons suggests that rotator cuff tendinopathy, subacromial impingement syndrome, or AC joint pathology are the most likely diagnoses in a young weightlifter with moderate intermittent right shoulder pain, due to repetitive overhead or heavy lifting mechanics 1
• Physical examination findings are more valuable than imaging in this population, with tests such as the painful arc test, Neer and Hawkins-Kennedy tests, cross-body adduction test, empty can test, Speed's and Yergason's tests being useful in diagnosing rotator cuff impingement, AC joint pathology, and biceps tendon pathology 1

Diagnostic Approach

• Imaging is not immediately necessary unless trauma occurred or symptoms persist beyond 6-8 weeks of conservative treatment, with plain radiographs being the first-line imaging modality if needed, followed by ultrasound or MRI only if surgical intervention is considered 1