Differential Diagnosis for Upper Chest Pain and Sternoclavicular Joint Swelling
- Single Most Likely Diagnosis
- Anterior sternoclavicular dislocation: This is the most common type of sternoclavicular dislocation, accounting for about 95% of cases. The anterior displacement of the clavicle is likely to cause swelling and tenderness of the sternoclavicular joint, consistent with the patient's symptoms.
- Other Likely Diagnoses
- Posterior sternoclavicular dislocation: Although less common than anterior dislocation, posterior dislocation can still occur, especially with a direct blow to the anterior chest or a fall onto an outstretched hand. However, the absence of neck vein engorgement or sensation pathology makes this less likely.
- Sternoclavicular joint sprain or strain: A less severe injury to the sternoclavicular joint can cause swelling and tenderness without frank dislocation.
- Do Not Miss Diagnoses
- Posterior sternoclavicular dislocation with vascular or respiratory compromise: Although the patient does not currently exhibit signs of neck vein engorgement or sensation pathology, a posterior dislocation can potentially compromise nearby vital structures, such as the trachea, esophagus, or major blood vessels. Missing this diagnosis could be catastrophic.
- Aortic dissection or rupture: Severe chest trauma can cause aortic injury, which would be a medical emergency. Although the patient's symptoms do not strongly suggest this, it is essential to consider it in the differential diagnosis.
- Rare Diagnoses
- Serendipitous discovery of a congenital sternoclavicular anomaly: Some individuals may have a congenital anomaly of the sternoclavicular joint that becomes apparent after a traumatic event.
- Inflammatory or infectious causes of sternoclavicular joint pain and swelling: Conditions like septic arthritis, rheumatoid arthritis, or other inflammatory arthropathies can affect the sternoclavicular joint, although these would be unusual in the context of acute trauma.