Differential Diagnosis for Severe Hand Pain and Swelling
- Single most likely diagnosis
- Hematoma or Soft Tissue Injury: Given the patient's report of severe pain, swelling, and visible bruising on the right wrist without a specific mechanism of injury, a spontaneous hematoma or soft tissue injury could be the most likely explanation. The patient's description of "pulsating veins" might be related to the swelling and bruising rather than an actual vascular issue.
- Other Likely diagnoses
- Gout or Pseudogout: These conditions can cause sudden, severe pain and swelling in the hands, especially if the patient has a history of diabetes, which can increase the risk of gout.
- Osteoarthritis or Rheumatoid Arthritis Flare: Although the patient does not have a mentioned history of arthritis, a flare of osteoarthritis or rheumatoid arthritis could cause severe pain and swelling in the hands.
- Infection (Cellulitis or Abscess): Bacterial infections can cause severe pain, swelling, and bruising, especially in diabetic patients who may have impaired circulation and immune response.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Deep Vein Thrombosis (DVT): Although the patient denies numbness or radiating pain, DVT should be considered, especially given her concern about "pulsating veins" and the potential for swelling and bruising.
- Septic Arthritis: This is a medical emergency that requires prompt diagnosis and treatment. The patient's symptoms of severe pain and swelling could be indicative of septic arthritis, especially if she has a history of diabetes or other immunocompromised conditions.
- Compartment Syndrome: This condition can cause severe pain, swelling, and bruising, and it is a medical emergency that requires immediate attention.
- Rare diagnoses
- Vasculitis: Conditions like giant cell arteritis or polyarteritis nodosa can cause severe pain, swelling, and bruising, but they are relatively rare and would require further evaluation.
- Sickle Cell Crisis: If the patient has sickle cell disease, a crisis could cause severe pain and swelling in the hands, although this would be less likely given the absence of other symptoms like fever or chest pain.