Most people who slip and fall get back up, brush themselves off, and figure the worst of it is a bruise. But a fall doesn’t need to be dramatic to cause real internal damage, and some of the most dangerous injuries don’t announce themselves until hours, days, or even weeks later.
Doctors have documented this delayed pattern, sometimes called a latent or asymptomatic period, since 1907, and it’s still a recognized feature of blunt trauma today.
Physical exams can be just as misleading in the early hours. Up to 10 to 20 percent of patients with a confirmed splenic injury show no obvious signs on initial exam. A normal exam right after a fall doesn’t rule out a serious injury developing underneath it.
Talk With a New York Personal Injury Lawyer at the Porter Law Group. Free, no-obligation, confidential.
Why Head Injuries Can Take Days to Show Up in Older Adults
Falls remain the leading cause of traumatic brain injury, and one of the harder patterns to catch is a subdural hematoma, bleeding between the brain and its outer covering, that doesn’t appear on the first scan.
In one case series, four elderly patients on blood-thinning or antiplatelet medication had a completely normal neurological exam and a normal CT scan right after their fall, then deteriorated between 9 hours and 3 days later as a delayed subdural hematoma developed. Three of the four needed emergency surgery.
This is specifically why clinical guidance recommends that older adults on anticoagulants or antiplatelet drugs be kept for extended observation after a head injury with an initially clean scan, even when they feel and look fine.
What Left Shoulder Pain After a Fall Can Actually Mean
Roughly 1 in 5 patients with a splenic injury develop Kehr’s sign, left shoulder pain caused by blood irritating the diaphragm, not a shoulder injury at all. The pain is referred there because the phrenic nerve, which supplies the diaphragm, shares the same cervical nerve roots as the nerves serving the shoulder.
It’s easy to write off as a shoulder strain from the fall itself, especially since it can show up or worsen while lying down, but in the context of a recent fall it’s one of the more specific signals of internal bleeding a person can notice without imaging.
Why Delayed Splenic Rupture Is Its Own Dangerous Pattern
The spleen is the most commonly injured organ in blunt abdominal trauma, and it has a well-documented failure mode: a tear that seems to be healing can suddenly give way, days after the original injury.
Delayed splenic rupture is defined as bleeding occurring 48 hours or more after the initial trauma, most commonly between 4 and 8 days later, though documented cases have occurred weeks afterward.
Mortality for a delayed rupture runs 5 to 15 percent, compared to roughly 1 percent for a rupture caught immediately, a tenfold difference that comes down almost entirely to how quickly it’s recognized.
What makes this pattern genuinely dangerous for someone going about their normal life afterward is that it isn’t limited to severe, high-impact trauma.
Published case reports describe delayed splenic rupture after nothing more than an accidental bump against furniture at home, and researchers caution that clinicians shouldn’t limit their suspicion to major traumatic events.
One case traced a splenic rupture back to a fall onto a concrete floor two weeks earlier, with no injury in between.
Signs of Internal Bleeding Worth Taking Seriously
| Sign or Symptom | What It May Indicate |
|---|---|
| Abdominal tenderness, rigidity, or distension | Internal bleeding or organ injury irritating the abdominal cavity |
| Left shoulder pain (Kehr’s sign) | Blood irritating the diaphragm, classically from a splenic injury |
| Left lower rib tenderness or fracture | Strongly associated with splenic injury |
| Dizziness, racing heart, low blood pressure | Hemodynamic instability from ongoing blood loss |
| Cold, clammy, or pale skin | Compromised circulation from blood loss |
| Worsening headache, confusion, or unusual drowsiness | Possible intracranial bleeding, including delayed subdural hematoma |
| New nausea, vomiting, or loose stools days after a fall | Can mimic a stomach bug but may reflect reduced blood flow from internal injury |
| Any symptom that worsens rather than improves over days | Evolving injury, not a healing one |
Why Falls Are Such a Common and Costly Injury
More than 1 in 4 older adults falls each year, and about 37 percent of those falls cause an injury serious enough to need medical treatment, adding up to roughly 3 million emergency department visits and about 1 million hospitalizations annually.
The age-adjusted fall death rate has climbed 21 percent in six years, from 64.7 per 100,000 older adults in 2018 to 78.4 per 100,000 in 2024, a trend that makes the case for taking a fall seriously stronger, not weaker, over time.
Who Faces the Highest Risk
Rib fractures are one of the clearer physical clues to what’s happening underneath. A large trauma-center study found that right-sided fractures of ribs 5 through 8 carry a 68 percent sensitivity for an associated liver injury, while left-sided fractures in that same range carry an 80 percent sensitivity for a spleen injury.
| Risk Factor | Why It Matters |
|---|---|
| Blood thinners (warfarin, apixaban, rivaroxaban) or antiplatelets (aspirin, clopidogrel) | Meaningfully raises bleeding risk from even minor trauma, and raises risk of delayed subdural hematoma specifically |
| Age 65 and older | Higher fall frequency, more fragile blood vessels, higher TBI hospitalization rates |
| Right-sided rib fracture, ribs 5 to 8 | 68% associated with liver injury |
| Left-sided rib fracture, ribs 5 to 8 | 80% associated with spleen injury |
| Recent abdominal trauma, even minor | Delayed splenic rupture has been documented after low-impact bumps, not just major accidents |
Severe internal injuries do occur in people with none of these risk factors. Their absence isn’t a reason to assume you’re safe.
How Doctors Actually Test for Internal Injuries
Physical exam and vital signs are the starting point, but as the numbers above show, they can miss an injury that hasn’t caught up to the body yet.
A FAST exam, bedside ultrasound looking for free fluid in the abdomen, is fast and highly specific when positive, around 99 percent in one large study, but its sensitivity was only about 33 percent in that same study, meaning a negative FAST result doesn’t rule out injury.
Contrast-enhanced CT remains the most reliable tool for detecting and grading organ injuries, which is why an initially clean CT still isn’t the final word if new symptoms show up later.
What New York Law Actually Requires of Property Owners
New York property owners owe a duty to act with ordinary, reasonable care under the circumstances, the standard set by the Court of Appeals in Basso v. Miller and applied the same way as any other negligence case.
That means keeping a property in reasonably safe condition given the likelihood someone could get hurt, how serious that harm could be, and how burdensome it would have been to prevent it.
New York also applies pure comparative negligence, so a jury can reduce your damages by whatever percentage of fault it assigns you rather than barring your claim outright.
A property owner isn’t automatically liable just because an accident happened on their property. What matters is whether a dangerous condition existed, whether the owner knew or reasonably should have known about it, and whether they failed to fix or warn about it within a reasonable time.
What Are the Key Deadlines in a New York Slip and Fall Case
| Situation | Deadline | Rule |
|---|---|---|
| Standard personal injury claim against a private property owner | 3 years from the date of the fall | CPLR 214 |
| Claim involving a minor | Toll extends until the child turns 18, then the 3-year clock runs | CPLR 208 |
| Claim against government-owned property (city sidewalk, subway station, public housing) | 90-day notice of claim, then suit generally within 1 year and 90 days | General Municipal Law 50-e |
Missing the 90-day notice deadline against a government entity generally bars the claim permanently, even if an internal injury only became apparent afterward. New York’s discovery rule can, in narrow circumstances, delay when the clock starts running until an injury is reasonably discoverable, but it’s not something to count on.
Given how many of the injuries described above take days or weeks to surface, the safer approach is prompt medical evaluation and prompt legal consultation, not waiting to see whether the discovery rule would apply to your situation.
Summing It Up
The pattern across all of this is consistent. A meaningful share of serious internal injuries, whether abdominal or intracranial, don’t show up on the first exam or the first scan.
If your fall happened on someone else’s property because of a hazard that should have been fixed or warned about, Porter Law Group can review what happened and explain what New York’s reasonable-care standard actually requires of the property owner.
Call 833-PORTER9 or email info@porterlawteam.com to schedule a free consultation.
Prior results do not guarantee a similar outcome.
Frequently Asked Questions
I fell days ago and felt fine, but now I have new symptoms. Should I still get checked out?
Yes. Delayed splenic rupture typically shows up 4 to 8 days after the original injury, and delayed subdural hematoma can take days to appear even after a clean initial scan. Tell the doctor about the earlier fall even if it feels like old news, since it changes what they’re looking for.
What does left shoulder pain after a fall usually mean?
It can be a shoulder strain, but it can also be Kehr’s sign, referred pain from blood irritating the diaphragm after a splenic injury, which affects roughly 1 in 5 patients with that kind of injury. If it follows a fall involving your torso, it’s worth mentioning specifically to whoever evaluates you.
Does a normal CT scan or ultrasound after a fall mean I’m in the clear?
Not entirely. A FAST ultrasound exam misses roughly two-thirds of true internal injuries in some studies, and even a clean initial CT hasn’t prevented documented cases of delayed bleeding showing up days later, especially in older adults on blood thinners.
Is a property owner automatically liable if I fell on their property?
No. New York requires property owners to use reasonable care under the circumstances, not perfection. Liability depends on whether a dangerous condition existed, whether the owner knew or should have known about it, and whether it went unaddressed for an unreasonable amount of time.
How much does a slip and fall lawyer cost in New York?
Porter Law Group works on a contingency fee basis. There’s no upfront cost, and no fee unless we recover compensation on your behalf.
This article is for informational purposes only and does not constitute legal advice. Attorney advertising. Prior results do not guarantee similar outcomes.
