Differential Diagnosis for Hand Pain
The patient presents with pain on the dorsum of the hand over the distribution of the fourth and fifth metacarpal bones without a history of injury. Based on the symptoms and examination findings, the following differential diagnoses are considered:
- Single most likely diagnosis
- Ulnar nerve compression or irritation: This condition could cause pain and tenderness in the area supplied by the ulnar nerve, which includes the fourth and fifth metacarpal bones. The absence of a history of injury and the specific location of the pain make this a plausible diagnosis.
- Other Likely diagnoses
- Tendinitis or tenosynovitis of the extensor tendons: Inflammation of the tendons on the back of the hand could cause pain and tenderness, especially over the metacarpal bones.
- Metacarpal stress fracture: Although there's no history of injury, stress fractures can occur without significant trauma, especially in individuals with repetitive stress on the hand.
- Ganglion cyst: Although no palpable mass is noted, a deep-seated ganglion cyst could cause pain and tenderness in the area.
- Do Not Miss diagnoses
- Osteomyelitis or septic arthritis: Infection of the bone or joint could present with pain and tenderness, even without significant erythema or warmth. It's crucial to consider this diagnosis to initiate prompt antibiotic treatment if necessary.
- Tumor (e.g., osteoid osteoma, giant cell tumor): Although rare, a tumor could cause localized pain and tenderness, and it's essential to rule out this possibility with imaging studies if the diagnosis remains unclear.
- Rare diagnoses
- Sarcoidosis: This systemic disease can cause granulomatous inflammation in various parts of the body, including the bones of the hand, leading to pain and tenderness.
- Gout or pseudogout: Although these conditions typically affect the joints, they can cause pain and inflammation in the surrounding soft tissues, including the area over the metacarpal bones.