Differential Diagnosis for Dorsal Hand Pain with Flexion of Middle and 4th Fingers
- Single most likely diagnosis: + Dupuytren's contracture: This condition is characterized by the thickening of the palmar fascia, leading to flexion deformity of the fingers, particularly the 4th and 5th fingers. However, it can also cause pain on the dorsal aspect of the hand due to the contraction of the fascia.
- Other Likely diagnoses: + Trigger finger: This condition occurs when the tendon sheath surrounding the tendon of the affected finger becomes inflamed, causing pain and stiffness, especially when flexing the finger. + Tendonitis or tenosynovitis: Inflammation of the tendons or their surrounding sheaths can cause pain and stiffness in the hand, particularly on the dorsal aspect. + Ganglion cyst: A ganglion cyst is a non-cancerous lump that can develop on the wrist or hand, causing pain and stiffness, especially if it compresses nearby nerves or tendons.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.): + Compartment syndrome: Although rare, compartment syndrome is a medical emergency that occurs when pressure within the muscle compartments increases, cutting off blood flow to the muscles and nerves. It can cause severe pain, especially on the dorsal aspect of the hand, and can lead to permanent damage if not treated promptly. + Infection (e.g., abscess or cellulitis): Infections can cause severe pain, redness, and swelling, and can lead to serious complications if not treated promptly.
- Rare diagnoses: + Kienbock's disease: A rare condition characterized by the collapse of the lunate bone in the wrist, causing pain and stiffness in the hand and wrist. + Gout or pseudogout: These conditions are characterized by the deposition of urate crystals or calcium pyrophosphate dihydrate crystals in the joints, causing severe pain and inflammation. Although rare in the hand, they can cause significant pain and stiffness.