Pain, swelling, tenderness, ecchymosis, and crepitus around the shoulder in an elderly patient after a fall most likely indicates which diagnosis?

• A. Clavicle fracture
• B. AC joint separation
• C. Glenoid labrum tear
• D. Humerus fracture

Answer: (D)

Pain with swelling, tenderness, ecchymosis, and crepitus around the shoulder after a fall in an elderly patient most strongly suggests a humerus fracture. Crepitus—a crackling sensation or sound from bone ends rubbing together—is a classic sign of bone disruption and is more characteristic of fracture than a soft-tissue injury. In older adults, osteoporosis makes fractures from low-energy falls common, and the proximal humerus or other parts of the humerus are frequent sites.

Other injuries can cause shoulder pain after a fall, but they don’t typically present with crepitus. A separation of the AC joint often shows prominent pain and swelling around the acromioclavicular area with potential deformity rather than the bone-end crepitus. Glenoid labrum tears cause pain and instability or mechanical symptoms without the bone-end crepitus. A clavicle fracture can occur with shoulder trauma, but crepitus around the shoulder is more emblematic of a fracture within the humerus rather than the clavicle.

Immediate steps involve immobilizing the arm, performing a neurovascular check, providing analgesia, and obtaining shoulder X-rays to confirm the fracture and guide management.