Differential Diagnosis for 74-year-old Female with Trauma
Single most likely diagnosis
- Osteoporotic fractures: Given the patient's history of osteoporosis and the mechanism of injury (fall onto the right side), it is likely that she has sustained fractures, particularly in the ribs, vertebrae, or hip, which would explain her neck pain, rib pain, and knee pain. The use of Fosamax (alendronate) may have helped to reduce the risk of fractures, but it does not eliminate the possibility entirely.
Other Likely diagnoses
- Musculoskeletal strain or sprain: The patient's fall and entanglement in cords could have resulted in muscle or ligament injuries, contributing to her pain and discomfort.
- Bruising or soft tissue injury: The fall and subsequent struggle to free herself from the cords may have caused bruising or soft tissue injuries, which could be painful and take time to heal.
- Vertebral compression fracture: Although the patient is taking Fosamax, her osteoporosis still puts her at risk for vertebral compression fractures, which could cause neck pain and pain with movement.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Pulmonary embolism: While less likely, a pulmonary embolism could be a life-threatening complication of trauma, especially in an elderly patient with osteoporosis and potential immobility.
- Aortic injury: Although rare, aortic injuries can occur with trauma, particularly in the elderly, and are often fatal if not promptly diagnosed and treated.
- Spinal cord injury: The patient's neck pain and mechanism of injury raise the possibility of a spinal cord injury, which would require immediate attention to prevent further damage.
Rare diagnoses
- Stress fracture: While the patient has osteoporosis, stress fractures are less common in this population and might not be the first consideration, but they could still occur, especially with unusual activity like vacuuming.
- Osteonecrosis: Although rare, osteonecrosis (avascular necrosis) could be a consideration, particularly if the patient has a history of steroid use or other risk factors, but it would be less likely in this scenario.