Differential Diagnosis for 59-year-old Female with Finger and Rib Injuries
- Single most likely diagnosis:
- Contusion or soft tissue injury of the left ring and third fingers, and left ribs. This is the most likely diagnosis given the patient's history of a fall onto her left side, resulting in tenderness, ecchymosis, and bruising to the affected areas.
- Other Likely diagnoses:
- Fracture of the left ring and third fingers, or left ribs. Although the patient declined X-rays, the mechanism of injury and symptoms could be consistent with fractures.
- Sprain or strain of the left arm or wrist. The patient reports mild discomfort to the left arm, which could be related to a sprain or strain from the fall.
- Hematoma. The patient is on Plavix, which increases the risk of bleeding and hematoma formation, especially given the trauma from the fall.
- Do Not Miss diagnoses:
- Vertebral fracture. Although the patient denies any head injury or loss of consciousness, a vertebral fracture could occur from a fall onto the side, and it's essential to consider this possibility, especially in an older adult.
- Internal injury (e.g., splenic or liver laceration). The patient reports bruising to the left ribs, which could be associated with internal injuries, especially given the mechanism of injury.
- Compartment syndrome. This is a rare but potentially devastating condition that could occur from increased pressure within the muscle compartments of the arm or hand.
- Rare diagnoses:
- Osteonecrosis or avascular necrosis of the affected bones. This could be a rare complication of the trauma, especially if the patient has a pre-existing condition that affects bone health.
- Complex regional pain syndrome (CRPS). This is a rare condition characterized by chronic pain, inflammation, and sensitivity, which could occur after a traumatic injury like a fall.