Differentials
Contusion
SIGNS / SYMPTOMS
May be very tender but usually more diffuse than with fracture. No deformity. Function usually preserved.
INVESTIGATIONS
X-rays negative.
Anterior glenohumeral dislocation
SIGNS / SYMPTOMS
May occur along with a humeral fracture. However, in an isolated glenohumeral dislocation, there is a characteristic deformity, and the humeral head can be palpated anterior and inferior to its usual location. If no concomitant fracture is present, bony point tenderness is absent.
INVESTIGATIONS
Anteroposterior and lateral x-ray views show no sign of fracture, but scapular "Y" and axillary lateral views show dislocated humeral head.
Rotator cuff injury
SIGNS / SYMPTOMS
Mainly in older patients. Pain usually more vague; tenderness diffuse.
Pain usually minimal with passive range of motion, but pain and weakness occurs with attempted active range of motion.
INVESTIGATIONS
X-rays negative.
Acromioclavicular joint sprain or fracture
SIGNS / SYMPTOMS
Tenderness, swelling, and possible deformity at acromioclavicular joint.
INVESTIGATIONS
X-rays may demonstrate fracture or widening at acromioclavicular joint.
Clavicle fracture
SIGNS / SYMPTOMS
Point tenderness, swelling, possible deformity and tenting at fracture site.
INVESTIGATIONS
X-rays demonstrate the fractured clavicle.
Elbow fracture
SIGNS / SYMPTOMS
Tenderness, swelling, and possible deformity at elbow.
INVESTIGATIONS
X-rays demonstrate the fractured elbow.
Elbow dislocation
SIGNS / SYMPTOMS
Elbow often held in flexion. Significant pain following active or passive movement. Olecranon is prominent and there is often significant amount of swelling around the joint.
INVESTIGATIONS
Standard anteroposterior and lateral x-ray views of the elbow joint are the preferred initial radiographic study.
Wrist fracture
SIGNS / SYMPTOMS
Undisplaced fractures usually present with localized swelling but no deformity. Tenderness over the distal radius is the hallmark. Displaced fractures often present with the classic "dinner fork" deformity. The wrist is tender, and range of motion is painfully limited.
INVESTIGATIONS
Posteroanterior, lateral, and oblique x-ray views of the wrist joint are the preferred initial radiographic study.
Pelvic fracture
SIGNS / SYMPTOMS
Pain, crepitus at pelvic fracture site, possible pelvic instability, hematuria, rectal bleeding, neurovascular deficits in lower limbs, or hematoma over ipsilateral flank, inguinal ligament, proximal thigh, or perineum.
INVESTIGATIONS
X-rays show fracture/disruption of normal pelvic anatomy.
Hip fracture
SIGNS / SYMPTOMS
Exam is usually nonspecific, but the leg on the affected side may be shortened and externally rotated if the hip fracture is displaced.
INVESTIGATIONS
Anteroposterior pelvic x-ray and a lateral x-ray of the affected hip show the hip fracture.
Hip dislocation
SIGNS / SYMPTOMS
Characteristic deformity; can mimic or be associated with femur fracture.
INVESTIGATIONS
X-rays show dislocation.
Knee injury
SIGNS / SYMPTOMS
Can mimic or be associated with distal femur fracture. Exam may show point tenderness and/or instability at the knee.
INVESTIGATIONS
X-rays reveal fracture and/or dislocation around the knee; if isolated ligamentous injury without dislocation, x-rays often negative.
Traumatic common peroneal nerve injury
SIGNS / SYMPTOMS
Tenderness and a positive Tinel sign (percussing nerve produces tingling or "pins and needles" in distribution of nerve) at common peroneal nerve over proximal fibula. May have radiating pain into leg and foot, paresthesias, numbness, and weakness at foot and ankle.
INVESTIGATIONS
X-rays negative.
Ankle fracture
SIGNS / SYMPTOMS
Tenderness, swelling, possible deformity at ankle. Laxity and/or gross instability may be noted on exam.
INVESTIGATIONS
X-rays may show fracture or instability pattern at ankle.
Use of this content is subject to our disclaimer