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Worsening Shoulder Pain in a Man After a Fall on the Ice


Two weeks after injury to the right chest wall and shoulder, the patient continues to have pain. He also reports numbness and tingling in his hands bilaterally. What do the ED images reveal?

Figure 1. Chest radiograph (Click figures to enlarge)

Figure 2. CT of the chest.

Figure 3. CT of the chest, coronal view.

Figure 4. CT of the chest, sagittal view

A 35-year-old man with no significant past medical history, presents to the emergency department (ED) with worsening right shoulder pain. He reports that he fell on the ice and injured the right chest wall and right shoulder, 2 weeks before presentation. He states that his pain has been worsening at the site of injury. The pain is relieved with NSAIDs. He reports that just recently he has begun to feel numbness and tingling in the third, fourth, and fifth finger digits bilaterally. He denies head trauma. He also denies any fevers, chills, weight loss, or sick contacts. He has no dyspnea or cough and has no recent travel history. The patient is a nonsmoker, works as a school teacher, and denies any occupational exposures.

The images shown in Figures 1-4 were obtained in the ED; there were no prior images for comparison.

   o What is your diagnosis in the setting of paresthesias and incidental radiographic findings after a fall?

   o What are the treatment options?

Please leave your impressions below; CLICK HERE for answers and discussion.

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