Differential Diagnosis for Jaelyn's Condition
- Single most likely diagnosis
- Subungual hematoma: This is the most likely diagnosis given the history of trauma to the finger, followed by the development of a black and blue discoloration under the fingernail, and increased pressure and throbbing pain, especially at night. The normal X-ray rules out a fracture but does not exclude a subungual hematoma.
- Other Likely diagnoses
- Fingertip pulp injury or contusion: The mechanism of injury (slamming the finger in the door) could also result in a pulp injury, which might explain the pain and pressure, especially if there is swelling or bruising of the fingertip pad.
- Nail bed injury or laceration: Although not explicitly mentioned, the trauma could have caused an injury to the nail bed, which might lead to similar symptoms, including pain and discoloration under the nail.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Compartment syndrome: Although less likely given the description, compartment syndrome is a serious condition that requires immediate attention. It could occur if there is significant swelling within the closed space of the finger, leading to increased pressure and potentially severe complications, including nerve and muscle damage.
- Infection (e.g., paronychia or felon): Infections in the finger can quickly become serious, especially if they involve the deeper tissues. While the current symptoms do not strongly suggest an infection, any signs of increasing redness, swelling, warmth, or pus would necessitate urgent evaluation.
- Rare diagnoses
- Raynaud’s phenomenon: This condition involves vasospasm of the arteries to the fingers, triggered by cold or stress, leading to discoloration and pain. However, it is less likely given the acute traumatic onset in this case.
- Glomus tumor: A rare, benign tumor of the nail bed that could cause pain and discoloration under the nail. However, these tumors are uncommon and would not typically present acutely following trauma.