Differential Diagnosis for 29-year-old Female with Hand and Shoulder Pain
Single Most Likely Diagnosis
- Rheumatoid Arthritis (RA): This is a common autoimmune disorder that often presents with symmetric polyarthritis, particularly affecting the hands and wrists. The patient's symptoms of hand pain, inability to hold objects, and subsequent shoulder pain could be indicative of RA, especially given the initial ER diagnosis of arthritis.
Other Likely Diagnoses
- Osteoarthritis (OA): Although less common in younger individuals, OA can cause significant pain and disability, especially if there's a history of trauma or repetitive strain on the joints.
- Fibromyalgia: Characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues, fibromyalgia could explain the patient's diffuse pain and sleep disturbances.
- Tendinitis/Bursitis: Inflammation of the tendons or bursae around the shoulder and hands could cause pain and limited mobility, fitting the patient's symptoms of shoulder pain and difficulty sleeping due to pain.
Do Not Miss Diagnoses
- Septic Arthritis: An infection within a joint, which is a medical emergency requiring prompt treatment to prevent joint destruction and systemic complications.
- Lupus: A systemic autoimmune disease that can cause arthritis, among other symptoms. Missing this diagnosis could lead to significant morbidity due to its potential to affect multiple organ systems.
- Gout: Especially if the patient has had sudden, severe attacks of pain, redness, and tenderness in joints, which could initially present in the hands or feet and later involve other joints.
Rare Diagnoses
- Psoriatic Arthritis: An autoimmune condition occurring in some people with psoriasis, characterized by joint pain, stiffness, and swelling, which could explain the patient's symptoms if there's an underlying psoriasis condition.
- Sjögren's Syndrome: An autoimmune disorder that can cause arthritis, among other symptoms like dry eyes and mouth. It's less common but should be considered in the differential for arthritis, especially if there are other systemic symptoms.
- Relapsing Polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, leading to joint pain and other symptoms, which might fit if the patient has additional symptoms like ear or nose cartilage involvement.