Differential Diagnosis for a 5-year-old with External Pain and Tremors after a Trampoline Fall

Single Most Likely Diagnosis

• Concussion or Mild Traumatic Brain Injury (mTBI): Given the mechanism of injury (fall on a trampoline) and the symptoms (external pain and tremors/shaking of the left hand and leg), a concussion is a plausible diagnosis. The external pain could be related to the impact, and the tremors might indicate a transient neurological disturbance.

Other Likely Diagnoses

• Musculoskeletal Injury: The fall could have resulted in injuries such as sprains, strains, or fractures to the limbs, which might cause pain and potentially some degree of tremor or shaking due to pain or muscle spasms.
• Peripheral Nerve Injury: Direct trauma to a nerve during the fall could cause pain, numbness, and tremors in the affected limb.

Do Not Miss Diagnoses

• Spinal Cord Injury: Although less likely, a spinal cord injury could occur from a trampoline fall, especially if there was a significant impact or an awkward landing. This would be a critical diagnosis not to miss due to the potential for long-term neurological deficits.
• Intracranial Hemorrhage: A more severe head injury could lead to bleeding within the brain, which is a medical emergency. Symptoms might not always be immediately apparent but could include worsening headache, vomiting, and alterations in consciousness.
• Cervical Spine Injury: Injury to the cervical spine could lead to serious neurological consequences if not promptly diagnosed and managed.

Rare Diagnoses

• Epileptic Seizure: Although rare, a seizure could be triggered by the head injury, and the shaking or tremors might be a manifestation of seizure activity.
• Conversion Disorder: In some cases, psychological trauma from the fall could lead to conversion disorder, where a child exhibits neurological symptoms (like tremors) without an identifiable neurological cause. This would be considered after ruling out other organic causes.