Differential Diagnosis for a 74-year-old man with inability to extend fingers and altered sensation after a fall
- Single most likely diagnosis:
- Radial nerve injury: The patient's inability to extend the fingers of the right hand and altered sensation on the palmar aspect of the hand suggests a radial nerve injury, which could have occurred when the arm was jammed between the floor and body. The radial nerve controls the extensor muscles of the wrist and fingers.
- Other Likely diagnoses:
- Brachial plexus injury: Given the mechanism of injury and the symptoms, a brachial plexus injury is possible, which could affect multiple nerves and lead to a variety of motor and sensory deficits.
- Ulnar nerve injury: Although less likely given the specific symptoms, an ulnar nerve injury could also result from the described trauma, affecting the ability to extend or adduct the fingers and potentially causing sensory changes.
- Do Not Miss diagnoses:
- Compartment syndrome: This is a medical emergency that could result from prolonged compression of the arm, leading to increased pressure within the muscle compartments, potentially causing nerve and muscle damage. Early recognition and treatment are crucial.
- Vascular injury: An injury to the blood vessels of the arm could lead to ischemia or other complications, necessitating prompt diagnosis and intervention.
- Rare diagnoses:
- Peripheral nerve tumors or cysts: Although rare, pre-existing conditions such as nerve tumors or cysts could potentially be exacerbated by the trauma, leading to the observed symptoms.
- Neurological conditions (e.g., amyotrophic lateral sclerosis, multifocal motor neuropathy): These conditions could present with similar symptoms but would be less directly related to the acute trauma described.