Differential Diagnosis for 44-year-old Female with Trauma to the Ulna
- Single most likely diagnosis:
- Ulnar fracture: The mechanism of injury, landing with the ulna to the bathtub, and the presence of bruising around the wrist that shoots up toward the elbow, are highly suggestive of a fracture to the ulna. The ulna is one of the two bones in the forearm, and a direct blow to this area can easily cause a fracture.
- Other Likely diagnoses:
- Radial fracture: Although the ulna was the point of impact, the force of the fall could have also affected the radius, the other bone in the forearm, leading to a fracture.
- Wrist sprain: The fall could have caused a sprain to the wrist, especially if there was any twisting motion involved.
- Elbow contusion or sprain: The bruising that extends up towards the elbow suggests that the elbow might have been affected by the fall, possibly resulting in a contusion or a sprain.
- Do Not Miss diagnoses:
- Compartment syndrome: This is a serious condition that can occur after a fracture or severe injury, where increased pressure within the muscle compartments can lead to nerve and muscle damage. It's crucial to monitor for signs of compartment syndrome, such as severe pain, pallor, poikilothermia, paresthesia, and pulselessness.
- Ulnar nerve injury: The ulnar nerve runs close to the surface of the ulna and can be injured in fractures or direct blows to this area. An injury to the ulnar nerve can lead to significant neurological deficits.
- Rare diagnoses:
- Monteggia fracture: This is a rare injury that involves a fracture of the ulna with a dislocation of the proximal radioulnar joint. It's an important diagnosis to consider because it requires specific treatment to avoid long-term complications.
- Osteochondritis dissecans: This condition involves a piece of cartilage and bone becoming detached from the surrounding bone, often due to trauma. It's less common but could be a consideration if the initial injury doesn't heal as expected or if there are persistent symptoms.