Differential Diagnosis for Right Hand Lock Up

The patient's symptoms of sudden right hand lock up after using them a lot, particularly in the context of working in construction and a history of a ladder falling on the hand, suggest several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Carpal Tunnel Syndrome (CTS): This condition is likely given the patient's occupation, which involves repetitive hand use, and the history of trauma. CTS can cause numbness, tingling, and pain in the hand, especially after activities that involve repetitive wrist motions. The fact that symptoms occur after heavy use and are associated with pain supports this diagnosis.

• Other Likely Diagnoses

  • Tendinitis or Tenosynovitis: Inflammation of the tendons or their surrounding sheaths due to overuse or direct injury from the ladder accident could lead to pain and stiffness, especially after prolonged activity.
  • Ganglion Cyst: A lump that can develop on the wrist or hand, often related to overuse or injury, which could cause discomfort and locking sensations if it interferes with tendon function.
  • Trigger Finger: A condition that affects the tendons in the fingers, causing them to catch or lock when flexed, which could be exacerbated by heavy use and previous trauma.

• Do Not Miss Diagnoses

  • Compartment Syndrome: Although less likely, this is a serious condition that could result from increased pressure within the compartments of the hand or forearm, potentially due to the trauma from the ladder. It requires immediate medical attention to prevent permanent damage.
  • Nerve Injury or Neuroma: Direct damage to nerves in the hand from the accident could lead to chronic pain, numbness, and dysfunction. Early diagnosis is crucial for effective management.
  • Osteoarthritis: While not immediately life-threatening, missing a diagnosis of osteoarthritis, especially post-trauma, could lead to significant long-term disability if not properly managed.

• Rare Diagnoses

  • Kienböck's Disease: A rare condition involving the collapse of the lunate bone in the wrist, which could be precipitated by trauma and lead to wrist pain and dysfunction.
  • Gout or Pseudogout: Although more commonly associated with the feet, these conditions can affect the hands and cause sudden, severe pain and swelling, potentially leading to locking sensations if the wrist or fingers are involved.

Each of these diagnoses should be considered in the context of the patient's history, physical examination, and potentially, further diagnostic testing such as X-rays, electromyography (EMG), or magnetic resonance imaging (MRI) to determine the underlying cause of the symptoms.