Differential Diagnosis for 24-year-old Female with Shoulder and Rib Pain
- 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, especially given the negative X-rays.
- Other Likely diagnoses:
- Soft tissue injury: The mechanism of injury and the patient's symptoms suggest a possible soft tissue injury, such as a contusion or sprain, which could be causing her pain.
- Rib contusion: The patient's report of rib pain is consistent with a rib contusion, which could have occurred during the fall or when she was being lifted up.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pneumothorax: Although the patient denies any respiratory symptoms and the X-rays are negative, a pneumothorax is a potentially life-threatening condition that must be considered, especially given the mechanism of injury and the location of her pain.
- Hemothorax: Similar to pneumothorax, a hemothorax is a serious condition that could be caused by the trauma and must be ruled out.
- Splenic or hepatic injury: Although the patient denies any abdominal symptoms, the possibility of splenic or hepatic injury must be considered, especially given the mechanism of injury and the location of her pain.
- Rare diagnoses:
- Scapular fracture: Although the X-rays are negative, a scapular fracture is a possible diagnosis that could be causing the patient's shoulder pain.
- Brachial plexus injury: The patient's symptoms of shoulder pain could be consistent with a brachial plexus injury, although this is a less likely diagnosis given the mechanism of injury and the lack of other symptoms such as numbness or tingling.