Differential Diagnosis for Wrist Pain and Swelling after a Fall
Single Most Likely Diagnosis
- Wrist Sprain: This is the most likely diagnosis given the mechanism of injury (fall) and the presence of pain and swelling in the wrist. A sprain occurs when the ligaments surrounding the wrist joint are stretched or torn, which can happen even without a fracture.
Other Likely Diagnoses
- Occult Fracture: Although the X-ray is negative, it's possible that a fracture may not be visible, especially if it's a non-displaced or hairline fracture. Further imaging or follow-up X-rays may be necessary to rule out this possibility.
- Wrist Contusion: A contusion, or bruise, can occur when blood vessels are damaged, leading to pain, swelling, and discoloration. This is a common injury after a fall and can be managed conservatively.
Do Not Miss Diagnoses
- Scaphoid Fracture: A scaphoid fracture is a specific type of wrist fracture that can be difficult to diagnose, as it may not be visible on initial X-rays. It's essential to consider this diagnosis, as a missed scaphoid fracture can lead to complications like avascular necrosis.
- Compartment Syndrome: This is a rare but potentially deadly condition that occurs when pressure builds up within the muscle compartments of the wrist, leading to nerve and muscle damage. It's crucial to monitor for signs of compartment syndrome, such as severe pain, numbness, and tingling.
Rare Diagnoses
- Wrist Tendon or Ligament Rupture: Although less common, a tendon or ligament rupture can occur after a fall, leading to significant pain and swelling. This diagnosis may require further imaging or surgical evaluation.
- Osteochondral Defect: An osteochondral defect is a rare condition where a piece of cartilage and bone becomes damaged or detached, leading to pain and swelling in the wrist. This diagnosis may require advanced imaging, such as an MRI, to confirm.