Differential Diagnosis for 27 yo Male Patient with Flexion Deformity at the PIP Joint of the Fifth Finger
- Single Most Likely Diagnosis
- Chronic tendon injury (e.g., mallet finger or boutonniere deformity): This is the most likely diagnosis given the flexion deformity at the PIP joint without signs of an acute fracture and the mention of findings that may represent chronic tendon injury in the impression.
- Other Likely Diagnoses
- Old fracture with malunion: Although the current findings do not show an acute fracture, an old fracture that healed in a malaligned position could result in a flexion deformity.
- Ligamentous injury: Chronic ligamentous injuries could lead to joint instability and deformity, although the preserved joint spacing in this case makes this less likely.
- Osteoarthritis: Early stages of osteoarthritis could potentially cause deformity, but this would be less common in a 27-year-old without other risk factors.
- Do Not Miss Diagnoses
- Infection (e.g., osteomyelitis or septic arthritis): Although less likely given the chronic nature of the presentation and the lack of signs of acute infection, missing an infection could have severe consequences, including destruction of the joint or spread of infection.
- Tumor (e.g., osteochondroma or giant cell tumor): Tumors could cause deformity and would be critical to diagnose early for appropriate treatment.
- Neurological conditions (e.g., ulnar nerve palsy): Certain neurological conditions could lead to flexion deformities due to muscle imbalance.
- Rare Diagnoses
- Dupuytren's contracture: A condition that causes thickening of the palmar fascia leading to flexion deformity of the fingers, more common in older adults.
- Psoriatic arthritis or other seronegative arthropathies: These conditions could cause joint deformities, including flexion deformities, but would typically be accompanied by other symptoms such as skin changes or eye inflammation.
- Congenital conditions (e.g., camptodactyly): Although the patient is an adult, some congenital conditions could present later in life or be noticed after a traumatic event.