Differential Diagnosis for Hand Swelling and Pain
Single Most Likely Diagnosis
- Psoriatic Arthritis: The erosion of the radial aspect of the head of the third middle phalanx, along with the absence of redness and warmth, suggests an inflammatory arthropathy. Psoriatic arthritis can cause asymmetric joint involvement and erosive changes, especially in the hands. The presence of osteoarthrosis and degenerative changes could be coincidental or related to the patient's age.
Other Likely Diagnoses
- Osteoarthritis with Erosive Changes: The patient has mild to moderate osteoarthrosis of the first metacarpophalangeal joint, and the erosion of the third middle phalanx could be an erosive form of osteoarthritis, known as erosive osteoarthritis.
- Gout: Although there's no mention of acute inflammatory signs, gout can cause chronic joint pain and swelling. The erosion of the phalanx could be due to a gouty tophus.
- Rheumatoid Arthritis: This is another inflammatory arthropathy that could cause erosive changes, although it typically involves more symmetric joint involvement.
Do Not Miss Diagnoses
- Infection (e.g., Osteomyelitis or Septic Arthritis): Although there's no redness, warmth, or emphysematous changes, it's essential to consider infection, especially if the patient has a history of immunocompromised status or recent trauma.
- Malignancy (e.g., Bone Tumor): A corticated fragment along the ulnar aspect of the base of the thumb proximal phalanx could be a sign of a bone tumor, and the erosion of the phalanx could be related to a malignant process.
Rare Diagnoses
- Sarcoidosis: This systemic disease can cause bone lesions and joint involvement, although it's less common.
- Multicentric Reticulohistiocytosis: A rare condition characterized by erosive arthritis and skin lesions.
- Erythromelalgia: A disorder that causes burning pain, heat, and redness in the hands and feet, although the patient's presentation lacks these typical symptoms.