The patient reports the onset of pain after falling onto his right shoulder while shoveling snow on his driveway one month earlier. Initially he was able to obtain some relief by alternating heat and ice along the lower right side of his neck and shoulder. However, over the last week the pain has become constant, now radiating down his right arm with numbness and tingling to his fourth and fifth fingers. He has been unable to obtain any relief even with over the counter pain medication. He us unable to lay directly on the right shoulder while sleeping.
He reports a general decrease in appetite, but feels this is associated with the onset of his pain. He is on blood pressure medication, has smoked for about 40 years and has no family history of cancer or diabetes. Upon further questioning the patient reveals fighting a mild cough on and off for about two-weeks. No other symptoms are reported.
Question 1: Before proceeding with an examination what are some differential diagnoses you might be considering?