Differential Diagnosis for 82 Year Old Female with Right Wrist and Hand Symptoms
Single Most Likely Diagnosis
- Osteoarthritis (OA): Given the patient's age and symptoms of joint pain, swelling, and stiffness, especially in the DIP joints which are commonly affected in OA, this diagnosis is highly plausible. The absence of systemic symptoms like fever and chills further supports this diagnosis.
Other Likely Diagnoses
- Rheumatoid Arthritis (RA): Although less likely than OA due to the patient's age and the lack of systemic symptoms, RA can still present in older adults and cause significant joint pain and swelling.
- Gout: The presence of severe pain, swelling, and redness, particularly if it involves the DIP joints, could suggest gout, especially if the patient has a history of hyperuricemia or kidney stones.
- Tendinitis or Tenosynovitis: The patient's symptoms of pain with movement and swelling could also be indicative of tendinitis or tenosynovitis, particularly affecting the tendons around the wrist.
Do Not Miss Diagnoses
- Septic Arthritis: Although the patient does not have fever or chills, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. The presence of severe joint pain, swelling, and warmth, even without systemic symptoms, mandates consideration of this diagnosis.
- Cellulitis or Abscess: The redness, swelling, and mild heat could also indicate a soft tissue infection like cellulitis or an abscess, which would require antibiotic treatment.
- Complex Regional Pain Syndrome (CRPS): The description of shooting/burning pain with movement could suggest CRPS, a condition that can follow trauma or immobilization and has significant implications for pain management and rehabilitation.
Rare Diagnoses
- Psoriatic Arthritis: This condition could present with joint pain and swelling, especially if there's a history of psoriasis. However, it's less common than OA or RA and might be considered if other diagnoses are ruled out.
- Hemochromatosis: Although rare, hemochromatosis can lead to OA-like symptoms due to iron deposition in joints. This would be considered if there's a family history or other suggestive findings.
- Scleroderma: This autoimmune disease can cause skin thickening and joint pain but is relatively rare and would typically be associated with other systemic symptoms.