Differential Diagnosis table forJoint dislocation
| Condition | Differentiating signs/symptoms | Differentiating tests |
| Proximal humerus fracture |
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| Distal clavicle fracture |
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Pain, particularly on upper extremity movement, and swelling.
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After the swelling has subsided, the fracture can often be felt through the skin.
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| Acromioclavicular joint separation |
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Pain is a common symptom of this injury and is usually severe.
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Evidence of traumatic injury to the shoulder, such as swelling and bruising, is also commonly found.
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AP x-ray rules out fractures.
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If diagnosis is unclear, an x-ray taken while the patient is holding a weight in the hand may be helpful. The force of the weight accentuates any shoulder joint instability and shows the effects of the injury better.
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| Rotator cuff tear |
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Shoulder pain is the most common presenting symptom.
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Pain is typically aggravated by over-head activities.
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Patients may also complain of functional weakness, loss of motion, night pain, and pain in the deltoid region.
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Acute pain and weakness may be seen following traumatic rotator cuff rupture.
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| Soft tissue contusion of the shoulder |
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| Scapula fracture |
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Relatively rare.
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Most patients present after high-energy trauma.
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Typically, there is swelling, tenderness, crepitus, and bruising over the scapular region.
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| Biceps tendon rupture |
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Some patients report a sudden pain in the anterior shoulder during activity.
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This acute pain, frequently described as sharp in nature, may be accompanied by an audible pop or a perceived snapping sensation.
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| Distal humerus fracture |
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| Radial head fracture |
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Usually presents with a history of a fall on the outstretched hand.
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Localised swelling, tenderness, and decreased motion to radial head.
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The wrist, especially the distal radioulnar joint, may be damaged simultaneously.
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| Coronoid fracture |
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Usually occurs in combination with a radial head fracture.
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Patients often present with a history of a fall on the outstretched hand and a deformity of the elbow.
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The presence of an unstable reduction of the elbow is suggestive of an associated coronoid fracture.
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Radiographs of the elbow in the AP, lateral, and, if required, oblique views should be obtained to ascertain clearly the extent of bony injury.
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| Ulnar collateral ligament injury |
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| Monteggia fracture |
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Depending on the type of fracture and severity, patients may experience elbow swelling, deformity, crepitus, and paraesthesia or numbness.
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Some patients may not have severe pain at rest, but elbow flexion and forearm rotations are limited and painful.
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Views of the forearm in orthogonal planes (planes at 90° to each other) are needed with the wrist and elbow joints included.
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Separate radiographs of the elbow should also be obtained to assess the proximal radioulnar joint, ulnohumeral articulation, and radiocapitellar joint.
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| Soft tissue contusion of the knee |
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Patients usually state that something struck the affected knee.
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On physical examination, there should not be any valgus laxity on abduction stress testing.
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| Chondromalacia patellae |
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Softening and fissuring of articular hyaline cartilage.
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Patients may report anterior knee pain, especially while climbing stairs.
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Compression of the patella during flexion and extension of the knee elicits crepitation and discomfort.
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| Patellar tendon rupture |
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Palpable defect in patellar ligament.
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With complete tears, patient is unable to extend the knee.
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With partial tears, patient is able to extend the knee, but extension may not be full.
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| Quadriceps tendon rupture |
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Usually occurs in patients over 40 years of age.
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Patients typically present with acute knee pain, swelling, and functional loss following a stumble, fall, or giving way of the knee.
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Obvious suprapatellar swelling, bruising, and tenderness are present.
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| Medial synovial plica of the knee |
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Symptoms may mimic those of a torn meniscus (e.g., snapping, clicking, and medial joint line tenderness).
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| Anterior cruciate ligament injury |
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| Posterior cruciate ligament injury |
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History of hyper-extension mechanism or a blow to anterior aspect of the knee.
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Difficulty going down inclines, descending stairs, or running down hills.
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| Medial collateral ligament injury of the knee |
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Sensation of side-to-side toggle with activity.
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Difficulty with twisting or turning.
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Difficulty with running or pivoting.
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| Posterolateral knee injury |
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| Meniscal tear |
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Patients frequently complain of mechanical symptoms in the knees such as catching, giving way, locking, clicking, and popping.
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On physical examination, meniscal injuries may present with quadriceps atrophy; they often have an associated knee effusion, and tenderness localised to the joint line may be present.
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| Osteochondral fracture of the knee |
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Patients have immediate pain and swelling of the knee at the time of injury.
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They also have significant pain with weight-bearing.
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The mechanism of injury usually involves a high-force, twisting injury of the knee.
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| Ligament avulsions of the finger |
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| Tendon avulsions of fingers |
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| Mallet finger |
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Patients notice the inability to extend the distal joint, although full passive extension remains intact.
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The dorsum of the joint may be slightly tender and swollen, but often the injury is painless or nearly painless.
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| Gamekeeper's thumb |
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A weakened ability to hold objects, decreased thumb stability (catching the thumb in objects, etc.), local swelling, local pain, and bruising.
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