Differential Diagnosis for Medial Nail/Finger Tenderness after Pulling a Hangnail
- Single most likely diagnosis:
- Paronychia: This is an infection of the skin around the nail, which can occur after trauma such as pulling a hangnail. The medial nail and finger tenderness are consistent with this diagnosis, especially if there's evidence of redness, swelling, or pus.
- Other Likely diagnoses:
- Herpetic whitlow: A viral infection caused by herpes simplex virus, leading to painful lesions on the finger, which could be mistaken for a hangnail or paronychia.
- Felon: An infection of the fingertip pulp, which can cause tenderness and pain, especially if the hangnail led to a puncture wound or introduction of bacteria.
- Nail bed injury: Direct trauma to the nail bed can cause pain and tenderness, especially if the hangnail was pulled aggressively.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Osteomyelitis: Although rare, an infection of the bone beneath the nail can occur, especially in individuals with compromised immune systems or diabetes. It requires prompt treatment to prevent serious complications.
- Septic arthritis: If the infection spreads to the joint, it can lead to septic arthritis, a condition that requires immediate medical attention to prevent joint destruction and systemic infection.
- Rare diagnoses:
- Glomus tumor: A rare, benign tumor of the nail bed that can cause pain and tenderness, especially to pressure.
- Squamous cell carcinoma: A type of skin cancer that can present as a non-healing lesion or sore around the nail, though it's extremely rare in this context.
- Melanonychia: A condition where a benign or malignant melanocytic lesion is present in the nail matrix, leading to nail pigmentation changes and potentially associated with pain or tenderness if advanced.