Differential Diagnosis for Bilateral Achy Hands

• Single most likely diagnosis
  • Osteoarthritis: This is the most common cause of bilateral achy hands, especially in older adults. It is characterized by joint pain, stiffness, and limited range of motion, often affecting the distal interphalangeal joints (DIP) and proximal interphalangeal joints (PIP).
• Other Likely diagnoses
  • Rheumatoid Arthritis (RA): An autoimmune disorder that causes inflammation and pain in the hands, often affecting the metacarpophalangeal joints (MCP) and PIP joints. Morning stiffness and symmetric joint involvement are common features.
  • Carpal Tunnel Syndrome: A condition that occurs when the median nerve is compressed at the wrist, leading to pain, numbness, and tingling in the hand, particularly in the thumb, index, and middle fingers.
  • Tendinitis: Inflammation of the tendons in the hands, often caused by repetitive strain or overuse, leading to pain and stiffness.
• Do Not Miss diagnoses
  • Giant Cell Arteritis: An inflammatory condition that can cause hand pain, especially if it involves the arteries supplying the hands. It is essential to consider this diagnosis due to its potential to cause blindness and other severe complications if left untreated.
  • Vasculitis: Inflammation of the blood vessels that can cause hand pain, numbness, and tingling. Certain types of vasculitis, such as Buerger's disease, can lead to severe complications like gangrene if not promptly treated.
• Rare diagnoses
  • Scleroderma: A chronic autoimmune disorder that can cause hand pain, stiffness, and thickening of the skin, often leading to limited range of motion and disability.
  • Psoriatic Arthritis: A type of arthritis that occurs in people with psoriasis, causing joint pain, stiffness, and swelling, often affecting the hands.
  • Hemochromatosis: A genetic disorder that leads to iron overload, which can cause joint pain and arthritis, including in the hands.