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A 49-Year-Old Man Comes to the Physician Because of a Two-Month

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A 49-year-old man comes to the physician because of a two-month history of right-sided neck, shoulder, and arm pain. The onset of the pain occurred a few days after he spent an afternoon chopping firewood. He describes the pain as constant and occasionally pulsating, especially at night. He also notes that his right arm alternates between warm and cold to the touch. He gets partial pain relief when he applies ice to the affected areas. He tried over-the-counter acetaminophen and ibuprofen without relief.
His other medical problems include hypertension, hypercholesterolemia, and gastroesophageal reflux disease. His medications include losartan, amlodipine, omeprazole, and simvastatin.
Physical examination is remarkable for tenderness over the right occipital area. There is mild edema of the fingers on the right hand. Neck motion is complete but slow in all directions. Neurological examination, including pinprick, motor strength, and deep tendon reflexes of the upper extremities, is unremarkable.
Laboratory results are as follows:
$A 49-year-old man comes to the physician because of a two-month history of right-sided neck, shoulder, and arm pain. The onset of the pain occurred a few days after he spent an afternoon chopping firewood. He describes the pain as constant and occasionally pulsating, especially at night. He also notes that his right arm alternates between warm and cold to the touch. He gets partial pain relief when he applies ice to the affected areas. He tried over-the-counter acetaminophen and ibuprofen without relief. His other medical problems include hypertension, hypercholesterolemia, and gastroesophageal reflux disease. His medications include losartan, amlodipine, omeprazole, and simvastatin. Physical examination is remarkable for tenderness over the right occipital area. There is mild edema of the fingers on the right hand. Neck motion is complete but slow in all directions. Neurological examination, including pinprick, motor strength, and deep tendon reflexes of the upper extremities, is unremarkable. Laboratory results are as follows: Radiographs of the cervical spine show some mild disk space narrowing at C5-C6 and C6-C7. A right shoulder x-ray demonstrates normal alignment, no fractures, and no calcifications. There is some patchy bone demineralization involving the acromion. Which of the following is the most likely diagnosis? A) Cervical radiculopathy B) Complex regional pain syndrome C) Fibromyalgia D) Polymyalgia rheumatica E) Systemic sclerosis$
Radiographs of the cervical spine show some mild disk space narrowing at C5-C6 and C6-C7. A right shoulder x-ray demonstrates normal alignment, no fractures, and no calcifications. There is some patchy bone demineralization involving the acromion.
Which of the following is the most likely diagnosis?

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