Differential Diagnosis for Charles' Left Hand Pain and Swelling

• Single Most Likely Diagnosis
  • Fracture: Given the history of overuse from chiseling and the presence of localized swelling, pain, and difficulty moving the fingers, a fracture is the most likely diagnosis. The mechanism of injury (repetitive strain from hammering) and the symptoms (swelling, pain, and limited mobility) align with a possible fracture, which needs to be confirmed with an X-ray.
• Other Likely Diagnoses
  • Soft Tissue Injury: This includes injuries to muscles, tendons, or ligaments, which could result from overuse or strain. The symptoms of pain, swelling, and difficulty moving the fingers could also be consistent with a soft tissue injury.
  • Tendonitis: Although initially deemed unlikely due to the absence of trauma, tendonitis could still be a consideration, especially given the overuse from hammering. Tendonitis involves inflammation of the tendons and could cause pain and swelling.
• Do Not Miss Diagnoses
  • Compartment Syndrome: This is a serious condition that occurs when pressure within the muscles builds to dangerous levels. It could be a consequence of a fracture or severe soft tissue injury. Symptoms include severe pain, swelling, and limited mobility, which are present in Charles' case. Missing this diagnosis could lead to serious complications, including nerve and muscle damage.
  • Infection (e.g., Cellulitis or Abscess): Although Charles denies any puncture wounds, the presence of swelling and pain could potentially indicate an infection, especially if the skin integrity was compromised during the chiseling activity. Infections can escalate quickly and become severe, making them a "do not miss" diagnosis.
• Rare Diagnoses
  • Osteonecrosis: This condition involves the death of bone tissue due to a lack of blood supply. It could potentially occur after a traumatic event or due to repetitive strain, but it is less common and would be considered a rare diagnosis in this context.
  • Ganglion Cyst: A ganglion cyst is a lump or mass that forms under the skin, often associated with a joint or tendon. While it could cause pain and swelling, it is less directly related to the acute onset of symptoms following overuse and is therefore considered rare in this scenario.