Differential Diagnosis for Acute Onset of Contractures of 4th and 5th Digits

• Single Most Likely Diagnosis
  • Dupuytren's contracture: This condition is characterized by the thickening of the palmar fascia, leading to contractures of the fingers, most commonly the 4th and 5th digits. The acute onset, however, is less typical as Dupuytren's contracture usually progresses slowly.
• Other Likely Diagnoses
  • Trauma: Acute injury to the hand or fingers can lead to contractures due to swelling, hematoma, or direct damage to the tendons or ligaments.
  • Infection (e.g., felon or paronychia): Infections of the fingertip or around the nail can cause pain, swelling, and stiffness, potentially leading to contracture if severe.
  • Stroke or cerebral vasospasm: Although less common, a stroke or cerebral vasospasm can cause sudden weakness or spasticity in the hand, potentially leading to contractures.
• Do Not Miss Diagnoses
  • Compartment syndrome: This is a medical emergency where increased pressure within a muscle compartment leads to nerve and muscle damage. It can cause severe pain, swelling, and contracture of the affected limb.
  • Volkmann's contracture: A deformity of the hand, fingers, and wrist caused by injury to the forearm. It is a complication of untreated or inadequately treated compartment syndrome and can result in permanent damage if not promptly addressed.
• Rare Diagnoses
  • Scleroderma: A chronic autoimmune disease characterized by thickening of the skin and connective tissue, which can lead to contractures of the fingers.
  • Diabetic cheiroarthropathy: A condition associated with diabetes that affects the hands, leading to limited joint mobility and potentially contractures.
  • Rheumatoid arthritis: Although more commonly associated with symmetric polyarthritis, rheumatoid arthritis can occasionally present with sudden onset of contractures in the hands, especially if there is a significant inflammatory flare.