What is the diagnosis and treatment for a patient who fell down the stairs, injuring her left wrist, right knee, and left ankle, presenting with discomfort, radiating pain, numbness, and tingling in the forearm and fingers, worsened by activity, with pain levels ranging from 4/10 to 8/10, and who denies taking any medication, including Toradol (Ketorolac)?

Differential Diagnosis

The patient presents with multiple injuries after a fall, including left wrist, right knee, and left ankle discomfort, with varying degrees of pain, numbness, and tingling. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Left Wrist Sprain/Strain: Given the mechanism of injury (fall onto an outstretched hand) and symptoms (discomfort, numbness, and tingling radiating to fingers), a left wrist sprain or strain is the most likely diagnosis.
  • Right Knee Contusion/Sprain: The patient's right knee discomfort, worsened by activity, suggests a contusion or sprain.
  • Left Ankle Sprain: The patient's left ankle discomfort, located on the outside of the foot, is consistent with a sprain.

• Other Likely Diagnoses

  • Left Wrist Fracture: Although less likely than a sprain, a fracture should be considered, especially given the mechanism of injury and the presence of numbness and tingling.
  • Right Knee Ligamentous Injury: The patient's knee discomfort, worsened by activity, could also be due to a ligamentous injury, such as an MCL or LCL sprain.
  • Left Ankle Fracture: Similar to the left wrist, a fracture should be considered, especially if the patient has significant pain or instability.

• Do Not Miss Diagnoses

  • Compartment Syndrome: This is a potentially deadly condition that can occur after a fracture or severe injury, characterized by increased pressure within a muscle compartment, leading to nerve and muscle damage.
  • Neurovascular Injury: Injury to the nerves or blood vessels in the affected areas could lead to serious complications, such as permanent nerve damage or ischemia.
  • Osteochondral Fracture: A fracture that involves the cartilage and bone, which can lead to long-term joint damage if not properly treated.

• Rare Diagnoses

  • Scaphoid Fracture: A specific type of wrist fracture that can be difficult to diagnose and may require special imaging studies.
  • Peroneal Tendon Injury: An injury to the tendons on the outside of the ankle, which can cause pain and instability.
  • Growth Plate Fracture: A type of fracture that occurs in children and adolescents, which can affect bone growth and development.