Differential Diagnosis for Bilateral Wrist Discomfort
- Single most likely diagnosis
- Carpal Tunnel Syndrome (CTS): The patient's symptoms of bilateral wrist discomfort, tingling in the 3rd and 4th fingers, and exacerbation of symptoms with activities like typing and taking manual blood pressures are classic for CTS. The fact that she has had a previous episode that resolved also supports this diagnosis.
- Other Likely diagnoses
- Repetitive Strain Injury (RSI): Given the patient's occupation as a medical assistant and her symptoms worsening with activities like typing and taking blood pressures, RSI is a possible diagnosis.
- Tendinitis: The patient's bilateral wrist discomfort could be due to tendinitis, especially if she has been performing repetitive activities that strain the tendons in her wrists.
- Ulnar Nerve Entrapment: The patient's symptoms of tingling in the 3rd and 4th fingers could also be consistent with ulnar nerve entrapment, although this is less likely given the bilateral nature of her symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Multiple Myeloma: Although rare, multiple myeloma can cause bilateral wrist pain and should be considered, especially if other systemic symptoms are present.
- Osteomyelitis: Infection of the bone, although unlikely given the patient is afebrile, could cause wrist pain and should be considered if the patient's symptoms worsen or if she develops systemic symptoms.
- Rheumatologic Disorders (e.g., Rheumatoid Arthritis): These disorders can cause bilateral wrist pain and should be considered, especially if the patient has other systemic symptoms or a family history of rheumatologic disorders.
- Rare diagnoses
- Thoracic Outlet Syndrome: This condition can cause nerve compression and lead to symptoms similar to those experienced by the patient, although it is less likely given the bilateral nature of her symptoms.
- Vitamin Deficiencies (e.g., Vitamin B12 deficiency): Certain vitamin deficiencies can cause nerve damage and lead to symptoms like tingling and numbness, although this is a less likely cause of the patient's bilateral wrist discomfort.