Differential Diagnosis for 24-year-old Female with Shoulder and Rib Pain after Fall
- Single most likely diagnosis:
- Musculoskeletal strain or bruising: The patient's symptoms of left posterior shoulder pain and rib pain after a fall while wearing a harness are consistent with a musculoskeletal strain or bruising, particularly given the mechanism of injury and the absence of any "red flag" symptoms.
- Other Likely diagnoses:
- Rib fracture: The patient's report of rib pain after a fall is concerning for a possible rib fracture, which is a common injury in falls or blunt trauma to the chest.
- Scapular fracture: The location of the patient's shoulder pain, described as posterior, could suggest a scapular fracture, especially if the patient landed on their shoulder or scapula during the fall.
- Acromioclavicular (AC) joint injury: The patient's shoulder pain could also be related to an AC joint injury, such as a sprain or separation, which can occur with falls onto the shoulder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Pneumothorax: Although the patient denies any symptoms suggestive of a pneumothorax, such as shortness of breath or chest pain, this diagnosis must be considered due to the potential for a rib fracture or other chest trauma to cause a pneumothorax, which can be life-threatening if not promptly diagnosed and treated.
- Hemothorax: Similar to pneumothorax, a hemothorax (blood in the thoracic cavity) is a potentially life-threatening condition that could result from severe chest trauma and must be ruled out.
- Spinal cord injury: Despite the patient wearing a harness and denying any loss of consciousness or head injury, the mechanism of injury could potentially involve spinal cord injury, especially if the fall was significant or the patient's body was twisted or compressed in a way that could affect the spine.
- Rare diagnoses:
- Sternal fracture: While less common than rib fractures, a sternal fracture could occur with severe chest trauma and might present with chest or shoulder pain.
- Clavicle fracture: A clavicle fracture is another possible injury from a fall onto the shoulder or outstretched hand, which could present with shoulder pain and limited mobility.