Differential Diagnosis for Swollen Middle Finger
Single Most Likely Diagnosis
- Osteoarthritis (OA): Given the morning stiffness and worsening pain at night, OA is a strong consideration, especially if the patient is older. The lack of trauma history and normal uric acid levels also point towards a degenerative condition like OA.
Other Likely Diagnoses
- Tendinitis: Inflammation of the tendons surrounding the finger could cause pain and swelling, especially with activities that involve gripping or bending.
- Ganglion Cyst: A common benign lump that can cause pain and swelling, often found on the wrist or fingers.
- Infectious Tenosynovitis: An infection of the tendon sheath, which could cause pain, swelling, and stiffness, particularly if the patient has a history of puncture wounds or recent infections.
Do Not Miss Diagnoses
- Osteomyelitis: A bone infection that could present with localized pain, swelling, and redness. Although less common, it's crucial to consider due to its potential severity and need for prompt antibiotic treatment.
- Septic Arthritis: An infection within the joint space, which is a medical emergency requiring immediate attention to prevent long-term damage.
- Malignancy (e.g., Bone Tumor): Although rare, a tumor could cause localized pain and swelling. A thorough investigation is necessary to rule out this possibility, especially if the pain is persistent and unexplained.
Rare Diagnoses
- Gout (despite normal uric acid levels): It's possible for uric acid levels to be normal during an acute gout attack. If other symptoms like sudden onset of intense pain, redness, and swelling are present, gout should still be considered.
- Sarcoidosis: A systemic disease that can cause inflammation and swelling in various parts of the body, including the fingers, though this would be an uncommon presentation.
- Psoriatic Arthritis: An autoimmune condition that can cause joint pain and swelling, often associated with psoriasis. It might be considered if the patient has a history of psoriasis or other autoimmune diseases.