Differential Diagnosis for Left Shoulder X-ray Findings
Single Most Likely Diagnosis
- Anterior shoulder dislocation with associated fractures: The presence of an anteroinferior shoulder dislocation, Hill-Sachs deformity, and a possible displaced greater tuberosity fracture, along with subtle irregularity of the anterior inferior glenoid suggestive of a bony Bankart fracture, points towards a complex shoulder injury. This combination of findings is commonly seen in traumatic anterior shoulder dislocations.
Other Likely Diagnoses
- Isolated greater tuberosity fracture: Although the primary diagnosis includes a dislocation, the mention of a calcified fragment suspicious for a displaced greater tuberosity fracture could also suggest an isolated fracture, especially if the dislocation has been reduced.
- Bony Bankart lesion: The subtle irregularity of the anterior inferior glenoid could be indicative of a bony Bankart lesion, which is a fracture of the glenoid rim. This is often associated with anterior shoulder dislocations but could be considered a distinct diagnosis if the dislocation is not the primary concern.
- Hill-Sachs lesion without dislocation: If the dislocation has been reduced or is not the primary focus, the Hill-Sachs deformity could be considered a standalone diagnosis, indicating a previous or chronic condition rather than an acute dislocation.
Do Not Miss Diagnoses
- Posterior shoulder dislocation: Although the findings suggest an anterior dislocation, a posterior dislocation could present with some similar radiographic findings, such as a reverse Hill-Sachs lesion (though not mentioned here). Missing a posterior dislocation could lead to significant morbidity if not promptly addressed.
- Scapular fracture: The normal appearance of the visualized scapula does not entirely rule out a scapular fracture, especially if the fracture is nondisplaced or located in an area not well-visualized on the provided images. Scapular fractures can be associated with significant complications if not properly managed.
Rare Diagnoses
- Osteochondral defect of the humeral head: While the Hill-Sachs deformity is indicative of a bony defect, a rare possibility could be an osteochondral defect, where both bone and cartilage are involved. This would typically require further imaging like an MRI for diagnosis.
- Glenoid labrum tear without bony fragment: Although the focus is on bony injuries, a glenoid labrum tear (SLAP lesion or Bankart lesion without a bony component) could be present and might not be visible on plain X-rays, requiring further diagnostic imaging like an MRI for detection.