Differential Diagnosis for Fall from 10 Feet with Left Shoulder and Neck Pain

Single Most Likely Diagnosis

• Left shoulder contusion or strain: The patient fell from a significant height and landed on their left shoulder, which directly correlates with the pain in the left upper trapezius and decreased active range of motion due to pain. The mechanism of injury and symptoms presented align closely with a soft tissue injury.

Other Likely Diagnoses

• Left clavicle fracture: Given the height of the fall and the impact on the left shoulder, a fracture of the clavicle is a plausible diagnosis. Clavicle fractures are common in falls onto the shoulder or outstretched hand.
• Left scapular fracture: Though less common than clavicle fractures, the force of the fall could potentially fracture the scapula, especially if the patient landed directly on it.
• Acromioclavicular (AC) joint sprain: The fall could have caused a sprain to the AC joint, which connects the acromion to the clavicle. This would result in pain and limited mobility in the shoulder.
• Cervical strain: The pain on the left side of the neck could indicate a strain of the cervical muscles, which could occur from the fall or from the body's reaction to the fall.

Do Not Miss Diagnoses

• Cervical spine fracture or dislocation: Although the patient did not hit their head and reports no dizziness, headache, nausea, or vomiting, a cervical spine injury could still be present. These injuries can be catastrophic if missed, and the mechanism of injury (a fall from over 10 feet) warrants careful consideration of this possibility.
• Pneumothorax or hemothorax: The force of the fall could potentially cause a lung injury, such as a pneumothorax (air in the chest cavity) or hemothorax (blood in the chest cavity), especially if there was a fracture of the ribs or other thoracic structures.

Rare Diagnoses

• Brachial plexus injury: The brachial plexus is a network of nerves that originates in the spinal cord and travels into the arm. A severe fall could potentially injure these nerves, leading to numbness, weakness, or paralysis of the arm.
• Thoracic outlet syndrome (TOS): This condition involves compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the thoracic outlet area, which lies between your collarbone (clavicle) and first rib. A fall could potentially cause or exacerbate TOS.