Differential Diagnosis for Wrist Pain in a 15-year-old
Single most likely diagnosis
- De Quervain's tenosynovitis: This condition is characterized by inflammation of the tendons on the thumb side of the wrist, which can cause pain and tenderness in the anatomical snuffbox. The patient's symptoms, such as tenderness to palpation and pain on active range of motion of the thumb, are consistent with this diagnosis.
Other Likely diagnoses
- Scaphoid stress fracture or contusion: Although the X-ray is normal, scaphoid fractures can be occult and may not be visible on initial X-ray. The anatomical snuffbox is a common location for scaphoid fractures.
- Wrist sprain: A sprain can cause pain and tenderness in the wrist, including the anatomical snuffbox.
- Ganglion cyst: A ganglion cyst is a benign lump that can occur on the wrist, including the anatomical snuffbox, and can cause pain and tenderness.
Do Not Miss diagnoses
- Scaphoid fracture with potential for avascular necrosis: If a scaphoid fracture is not diagnosed and treated promptly, it can lead to avascular necrosis, which can result in long-term disability.
- Infectious tenosynovitis: Although less likely, infectious tenosynovitis is a serious condition that requires prompt diagnosis and treatment to prevent long-term damage.
Rare diagnoses
- Gout or pseudogout: These conditions are rare in adolescents, but can cause sudden onset of wrist pain and swelling.
- Osteoid osteoma: A benign bone tumor that can cause pain and tenderness in the wrist, including the anatomical snuffbox.
- Kienbock's disease: A rare condition characterized by avascular necrosis of the lunate bone, which can cause wrist pain and stiffness.