Differential Diagnosis for Hand Pain and Swelling

The patient presents with a three-day history of hand pain and swelling without a clear etiology, negative X-ray for fracture, and some relief with ibuprofen. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Inflammatory Arthritis (e.g., Rheumatoid Arthritis, Psoriatic Arthritis): Given the generalized pain and swelling in the hand, exacerbated by movement, and the absence of trauma, inflammatory arthritis is a plausible diagnosis. The patient's ability to find some relief with ibuprofen also supports this, as NSAIDs can help reduce inflammation and pain associated with arthritis.
• Other Likely Diagnoses
  • Tendinitis or Tenosynovitis: Inflammation of the tendons or their surrounding sheaths could cause pain and swelling, especially with movement. The lack of trauma does not rule out overuse injuries leading to tendinitis.
  • Gout or Pseudogout: Although more commonly associated with the feet, gout and pseudogout can affect the hands. The acute onset of pain and swelling, even without a history of similar episodes, makes these conditions possible.
  • Infection (e.g., Cellulitis, Abscess): While the patient denies any breaks in the skin or recent surgeries, infections can occur without an obvious source. The swelling and pain could be indicative of a soft tissue infection.
• Do Not Miss Diagnoses
  • Osteomyelitis or Septic Arthritis: Although less likely given the lack of systemic symptoms (e.g., fever) and negative X-ray, these conditions are medical emergencies that could present with localized pain and swelling. Missing these diagnoses could lead to severe consequences, including loss of function or life-threatening complications.
  • Compartment Syndrome: This is a serious condition that could result from increased pressure within the compartments of the hand, leading to pain, swelling, and potentially permanent damage if not promptly treated.
• Rare Diagnoses
  • Sarcoidosis: A systemic disease that can cause inflammation in various parts of the body, including the hands, though it is less common.
  • Scleroderma or Systemic Sclerosis: An autoimmune disease that can lead to swelling and pain in the hands among other symptoms, but it typically presents with other systemic manifestations.
  • Complex Regional Pain Syndrome (CRPS): A condition characterized by intense burning or aching pain in the hands or feet after an injury or trauma, which the patient denies, but it's worth considering given the severity of pain and swelling.

Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and potentially additional diagnostic tests to determine the underlying cause of the hand pain and swelling.