Differential Diagnosis for Wrist and Finger Pain after Injury
Single Most Likely Diagnosis
- Osteoarthritis (OA): The presence of degenerative changes, perarticular spurring, loss of articular space, and subarticular cystic changes are all characteristic of OA. The involvement of specific joints such as the first carpometacarpal articulation and the distal interphalangeal joints further supports this diagnosis, as these are common sites for OA.
Other Likely Diagnoses
- Psoriatic Arthritis: This condition can cause degenerative changes and joint space narrowing, similar to OA. However, it often involves the distal interphalangeal joints and can cause fragmentation of bone, which is noted in the second and fifth distal interphalangeal articulations.
- Rheumatoid Arthritis (RA): Although RA typically involves the metacarpophalangeal and proximal interphalangeal joints, the presence of degenerative changes and loss of articular space in the lateral wrist and second metacarpophalangeal articulation could suggest RA, especially if the patient has a history of systemic symptoms.
- Traumatic Arthritis: Given the patient's history of injury, traumatic arthritis is a possibility, especially if the injury caused chronic inflammation and degenerative changes in the affected joints.
Do Not Miss Diagnoses
- Septic Arthritis: Although the X-ray does not show signs of an acute infection, septic arthritis can cause rapid destruction of the joint and must be considered, especially if the patient has symptoms such as fever, redness, or swelling.
- Gout: Gouty arthritis can cause joint destruction and fragmentation, similar to what is seen in the X-ray. A history of sudden, severe attacks of pain and swelling would support this diagnosis.
- Ligamentous Injury: The absence of acute fracture or dislocation does not rule out a ligamentous injury, which could be causing the patient's pain and degenerative changes.
Rare Diagnoses
- Hemochromatosis: This genetic disorder can cause degenerative joint disease, particularly in the second and third metacarpophalangeal joints, due to iron deposition.
- Wilson's Disease: A rare genetic disorder that can cause degenerative changes in the joints, as well as neurological symptoms.
- Spondyloarthritis: A group of diseases that can cause inflammation and degenerative changes in the joints, including the wrists and fingers.