Differential Diagnosis for 88 y/o Female with Painful Middle Finger
- Single most likely diagnosis
- Paronychia or nail bed infection (unlikely given the lack of redness and heat, but possible if the infection is deep or partially treated) - The patient's recent nail cut and exposure to a potentially contaminated object (plastic hook) could have introduced bacteria into the nail bed, leading to infection.
- Other Likely diagnoses
- Nail bed trauma or contusion - The injury from cutting the nail on a hook could have caused a bruise or damage to the nail bed, leading to persistent pain.
- Onychialgia (nail pain) due to nail plate or nail bed irritation - The cut nail could be putting pressure on the surrounding tissue or nail bed, causing pain.
- Osteoarthritis or other degenerative joint disease - The patient's age and the location of the pain (finger) could suggest an underlying joint condition contributing to the pain.
- Do Not Miss diagnoses
- Osteomyelitis (bone infection) - Although less likely given the lack of systemic symptoms, osteomyelitis can occur after a puncture wound and may not always present with typical signs of infection like redness and heat, especially in the elderly.
- Septic arthritis - If the infection spread to the joint, it could lead to septic arthritis, which is a medical emergency.
- Tetanus - Given the mechanism of injury (cut on a potentially dirty object), tetanus infection is a possibility, although rare in individuals with up-to-date vaccinations.
- Rare diagnoses
- Glomus tumor - A rare, benign tumor of the nail bed that could cause localized pain.
- Subungual melanoma - A type of skin cancer that can occur under the nail and cause pain, although it would be unusual for it to present so acutely after a minor injury.
- Digital neuropathy - Damage to the digital nerves could cause pain, but this would be less directly related to the injury described.