Differential Diagnosis for Thumb Pain at the Base
Single Most Likely Diagnosis
- De Quervain's Tenosynovitis: This condition, which affects the tendons on the thumb side of the wrist, is a common cause of pain at the base of the thumb, especially in women. The patient's demographics and symptom location make this a highly plausible diagnosis.
Other Likely Diagnoses
- Osteoarthritis of the First Carpometacarpal Joint: Given the patient's age and the location of the pain, osteoarthritis of the joint at the base of the thumb is a likely consideration. This condition is common and can cause significant pain and dysfunction.
- Thumb Sprain: A sprain, particularly of the ulnar collateral ligament of the thumb, could cause pain at the base of the thumb. This is a common injury, often resulting from a fall onto the thumb or a sudden twisting motion.
- Ganglion Cyst: A ganglion cyst, which is a benign lump, can develop near the joints or tendons of the wrist and hand, including the base of the thumb, causing pain and discomfort.
Do Not Miss Diagnoses
- Infection (e.g., Septic Arthritis or Osteomyelitis): Although less common, an infection in the joint or bone at the base of the thumb could have severe consequences if not promptly treated. Symptoms might include redness, swelling, warmth, and significant pain.
- Gout: While less likely, gout can affect the joints of the hand, including those at the base of the thumb. It's essential to consider this diagnosis, especially if the patient has a history of gout or risk factors such as kidney stones or certain medications.
- Fracture: A fracture of one of the bones at the base of the thumb, such as a scaphoid fracture, could cause significant pain. This is particularly important to consider if there was a traumatic event.
Rare Diagnoses
- Tumor (Benign or Malignant): Tumors, whether benign (like a giant cell tumor) or malignant, can occur in the bones or soft tissues at the base of the thumb, causing pain. These are much less common than other causes but should be considered if other diagnoses are ruled out.
- Sarcoidosis: This systemic disease can cause inflammation and pain in various parts of the body, including the joints and bones of the hand. It's a rare cause of thumb pain but should be considered in patients with a history of sarcoidosis or other systemic symptoms.