Differential Diagnosis for Bilateral Fourth Digit Flexor Tenosynovitis
- Single most likely diagnosis
- Trigger finger (stenosing tenosynovitis): This condition is characterized by inflammation and thickening of the tendon sheath, leading to tendon impingement and flexor tenosynovitis, which matches the symptoms described. The A1 pulley thickening is a common finding in trigger finger.
- Other Likely diagnoses
- Repetitive strain injury: Repeated strain on the flexor tendons can cause tenosynovitis and tendon impingement, especially if the individual performs activities that involve repetitive gripping or flexion of the fingers.
- Rheumatoid arthritis: Although less common, rheumatoid arthritis can cause tenosynovitis and tendon impingement, especially in the context of bilateral involvement.
- Do Not Miss diagnoses
- Infectious tenosynovitis: Although less likely, infectious tenosynovitis (e.g., due to bacterial or fungal infection) can have severe consequences if left untreated, including tendon rupture or spread of infection.
- Gout or pseudogout: These conditions can cause sudden, severe inflammation of the tendons and joints, and although rare, they should be considered to avoid missing a potentially treatable condition.
- Rare diagnoses
- Sarcoidosis: This condition can cause tenosynovitis and tendon impingement, although it is a rare cause of these symptoms.
- Amyloidosis: Amyloid deposits can cause tenosynovitis and tendon impingement, but this is a rare condition that would typically be associated with other systemic symptoms.