Hand Pain: Or something else? Differential Diagnosis

Infectious and parasitic diseases (A00-B99).

  • Infection, unspecified

Musculoskeletal system and connective tissue (M00-M99).

  • Osteoarthritis, e.g., rhizarthrosis (thumb saddle joint osteoarthritis) [load-dependent pain at the junction of the thumb (1st metacarpal bone) and the wrist].
  • Chondrocalcinosis (synonym: pseudogout); gout-like disease of the joints caused by deposition of calcium pyrophosphate in cartilage and other tissues; leads, among other things, to joint degeneration (often of the knee joint); symptomatology resembles an acute attack of gout → joint degeneration
  • Ganglion (overbone); about 90% of cases dorsal; symptoms: pain due to pressure on underlying structures.
  • Gout (arthritis urica / uric acid-related joint inflammation or tophic gout)/hyperuricemia (increase in uric acid levels in the blood); restricted mobility of the joint.
  • Bone cysts / enchondromas – encapsulated fluid-filled cavities.
  • Monarthritis (see above gout)
  • Kienböck’s disease – bone necrosis of the lunate bone (Os lunatum).
  • Preiser’s disease – bone necrosis of the scaphoid bone (Os scaphoideum).
  • Pisiformitis (irritation of the pea bone (Os pisiform)).
  • Reactive arthritis (synonym: postinfectious arthritis / joint inflammation) – second disease after gastrointestinal (gastrointestinal tract concerning), urogenital (urinary and genital organs concerning) or pulmonary (lungs concerning) infections; refers to an arthritis, where pathogens in the joint (usually) can not be found (sterile synovialitis).
  • Reiter’s disease (synonyms: Reiter’s syndrome; Reiter’s disease; arthritis dysenterica; polyarthritis enterica; postenteritic arthritis; posturethritic arthritis; undifferentiated oligoarthritis; urethro-oculo-synovial syndrome; Fiessinger-Leroy syndrome; English Sexually acquired reactive arthritis (SARA)) – special form of a “reactive arthritis” (see above. ); secondary disease after gastrointestinal or urogenital infections, characterized by the symptoms of Reiter’s triad; seronegative spondyloarthropathy, which is triggered especially in HLA-B27 positive persons by an intestinal or urinary tract disease with bacteria (mostly chlamydia); Can manifest as arthritis (joint inflammation), conjunctivitis (conjunctivitis), urethritis (urethritis) and partly with typical skin changes.
  • Rheumatoid arthritis (synonym: chronic polyarthritis) – chronic inflammatory multisystem disease, usually manifested in the form of synovitis (synovial inflammation); symptoms: mostly polyarthritis (centripetal and symmetrical progression); morning stiffness (> 30 (-60) minutes).
  • Rupture of a tendon (e.g., in tendovaginitis); complaint: reduced limited strength.
  • Damage to the radial nerve due to pressure on the radial nerve at the middle posterior part of the humerus; complaint: hypesthesia (decreased sensitivity of the skin) and drop hand; extensor function in the wrist and fingers is limited
  • Synovialitis – inflammation of the inner layer of the joint capsule.
  • Tendovaginitis (tendonitis) in the wrist area.
  • Tendovaginitis stenosans (Quervain’s disease; synonyms: “housewife’s thumb”, fasting finger; snapping finger); Tendovaginitis stenosans de Quervain (“housewife’s thumb”); nonspecific inflammation in the area of the tendon sheaths of the abductor pollicis longus muscle and the extensor pollicis brevis muscle in the first extensor tendon compartment; complaint: Combination of wrist pain and impaired grip; pain in or near the thumb-side wrist; radiates clustered toward the forearm and is increased with exertion
  • Ratio of length of ulna and radius near wrist: Ulna-minus variant (ulna applied too short); Ulna-plus variant (ulna applied too long).

Neoplasms – tumor diseases (C00-D48).

  • Neoplasms, unspecified
  • Metastases of unspecified neoplasms.

Psyche – nervous system (F00-F99; G00-G99)

  • Carpal tunnel syndrome (KTS) – nerve compression syndrome (median nerve in the region of the carpal canal); symptoms: tingling and numbness also pain in the wrist; falling asleep of the hand, especially at night (brachialgia paraesthetica nocturna) [often both hands are affected; risk of confusion with cervical spine syndrome, polyneuropathy or cervical myelopathy].
  • Neuritis nervi ulnaris (synonym: ulnar sulcus syndrome) – the ulnar nerve is palpable along its course on the medial humerus at the elbow. In this area, compression can be caused by adhesions or muscle parts or stretching of the nerve. Complaints: pain and paresthesias (insensations) in the 4th and 5th fingers; paresis and atrophy of the small muscles of the hand enervated by the ulnar nerve up to the claw position of the ring and little finger (claw hand).

Causes (external) of morbidity and mortality (V01-Y84).

  • Finger/wrist distortion; contusion/sprain.
  • Scaphoid fracture – fracture (fracture) of a scaphoid bone (os scaphoideum of the carpus); usually caused by a fall onto the maximally extended hand, which is angled toward the thumb in the process
  • Distal radius fracture
  • Accident

Injuries, poisonings and other consequences of external causes (S00-T98).

  • Fracture (bone fracture); complaint: tenderness at the fracture site/dislocation (including radial fracture, fracture of the os scaphoideum).