Differential Diagnosis for a 30-year-old man with symptoms after cranking up a gate on a semi-truck trailer
- Single most likely diagnosis:
- Rupture of the left biceps tendon: The patient's symptom of the biceps muscle being "shrunk up towards the shoulder" after a popping sound is highly suggestive of a biceps tendon rupture. This injury is common in activities that involve heavy lifting or sudden contraction of the biceps, which could have occurred when the patient was cranking up the gate.
- Other Likely diagnoses:
- Strain or partial tear of the biceps or brachialis muscle: These injuries could also result from the sudden force exerted while cranking the gate and might present with similar symptoms, although perhaps less severe than a complete rupture.
- Radial or median nerve injury: The tingling sensation in the forearm could indicate nerve damage. The radial nerve runs close to the area where the biceps tendon is located and could be injured in a similar mechanism, leading to symptoms like tingling or numbness in the forearm.
- Do Not Miss diagnoses:
- Brachial artery injury: Although less likely, an injury to the brachial artery could occur from the trauma and would be a medical emergency. The coldness of the forearm could be indicative of decreased blood flow, making this a critical diagnosis not to miss.
- Compartment syndrome: This is a condition where increased pressure within a muscle compartment leads to inadequate blood supply to the tissues inside the compartment. It can result from severe injury, including those that cause significant swelling or bleeding within a closed space, and is a medical emergency.
- Rare diagnoses:
- Humerus fracture: A fracture of the humerus could potentially occur from a fall or direct blow during the incident, although the mechanism described (cranking a gate) makes this less likely.
- Thoracic outlet syndrome: This condition involves compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the thoracic outlet area, which could potentially cause some of the symptoms described, such as tingling and coldness. However, it would be an unusual direct result of the described incident.