Differential Diagnosis for Fall and Shoulder Pain
- Single Most Likely Diagnosis
- Fracture of the proximal humerus: This is a common injury in older adults after a fall, especially if the fall was onto an outstretched hand or directly onto the shoulder. The proximity of the fall to the shoulder and the mechanism of injury make this a highly plausible diagnosis.
- Other Likely Diagnoses
- Rotator cuff injury: Falls can cause direct trauma to the shoulder, leading to strains or tears of the rotator cuff muscles or tendons. This is particularly likely if the patient reports pain with movement of the shoulder.
- Acromioclavicular (AC) joint separation: A fall onto the shoulder or outstretched hand can cause a separation of the AC joint, leading to pain and instability in the shoulder region.
- Clavicle fracture: A direct blow to the shoulder or a fall onto an outstretched hand can result in a fracture of the clavicle, which would cause significant pain and potentially a visible deformity.
- Do Not Miss Diagnoses
- Vertebral fracture: Although less common than shoulder injuries, a fall can also result in a vertebral fracture, especially in individuals with osteoporosis. Missing this diagnosis could lead to serious complications, including spinal cord injury.
- Brachial plexus injury: A severe fall could potentially injure the brachial plexus, a network of nerves that originates in the spinal cord and controls muscle function in the shoulder, arm, and hand. This injury could lead to significant and potentially permanent neurological deficits if not promptly addressed.
- Pulmonary injury (e.g., pneumothorax): A fall with significant trauma to the chest or shoulder region could also result in a pulmonary injury, such as a pneumothorax, which is life-threatening and requires immediate medical attention.
- Rare Diagnoses
- Scapular fracture: While fractures of the scapula can occur from a fall, they are relatively rare compared to other shoulder injuries. They often result from high-energy trauma.
- Sternoclavicular (SC) joint dislocation: This is a less common injury compared to AC joint separations but can occur from a fall onto the shoulder or chest. It may present with pain and swelling in the area of the SC joint.