Differential Diagnosis for a 46-year-old Female with a Swollen Thumb
Single most likely diagnosis
- De Quervain's tenosynovitis: This condition, which affects the tendons on the thumb side of the wrist, is a common cause of thumb pain and swelling, especially in women. The inability to bend the thumb and pain are consistent with this diagnosis.
Other Likely diagnoses
- Trigger thumb: This condition occurs when the tendon sheath surrounding the tendon of the thumb becomes inflamed, causing pain and stiffness. The symptom of not being able to bend the thumb could be related to a trigger thumb.
- Thumb sprain: A sprain could cause swelling, pain, and limited mobility of the thumb. This is a common injury that could fit the symptoms described.
- Osteoarthritis of the thumb: Although less common in a 46-year-old without a history of trauma or repetitive strain, osteoarthritis could cause pain, swelling, and limited mobility of the thumb.
Do Not Miss diagnoses
- Infection (e.g., cellulitis or abscess): Although less likely, an infection could cause swelling, pain, and limited mobility. Missing an infection could lead to serious complications, so it's crucial to consider this in the differential diagnosis.
- Gout: While more commonly associated with the big toe, gout can affect any joint, including those in the thumb. It would be a mistake to overlook gout, given its potential for severe pain and the importance of early treatment.
- Fracture: A fracture of one of the bones in the thumb could cause pain, swelling, and an inability to bend the thumb. This is a critical diagnosis not to miss, as improper healing could lead to long-term disability.
Rare diagnoses
- Giant cell tumor of the tendon sheath: A rare, benign tumor that could cause swelling and pain in the thumb.
- Sarcoidosis: A systemic disease that could cause inflammation and swelling in various parts of the body, including the thumb, though this would be an uncommon presentation.
- Psoriatic arthritis: Although more commonly associated with skin symptoms, psoriatic arthritis could cause joint inflammation and pain in the thumb, among other areas.