From the Guidelines
I recommend continuing the current treatment plan for the 36-year-old male with left wrist pain, as the patient has already shown improvement after changing his posture while using his table, and the x-ray showed no arthritic or post-traumatic bony changes. The patient should wear the prescribed wrist brace for support and take ibuprofen 400 mg three times daily as needed for 30 days. According to the most recent guidelines, radiography is usually appropriate as the initial imaging study in the evaluation of chronic hand or wrist pain 1. Since the x-ray showed no abnormalities, the next step would be to consider advanced imaging with MRI or CT if the pain persists, as suggested by the American College of Radiology Appropriateness Criteria 1. However, given the patient's improvement with posture changes, it is reasonable to continue conservative management for now.
The wrist brace will help immobilize the joint and reduce strain during activities, while ibuprofen will help reduce inflammation and pain. A follow-up appointment in 60 days is appropriate to assess the effectiveness of these interventions and determine if further treatment is necessary. If pain worsens before the follow-up appointment, the patient should seek medical attention sooner. It is also important to note that MRI without IV contrast or CT without IV contrast may be considered as the next imaging study if the pain persists, as they are equivalent alternatives for evaluating chronic wrist pain following normal radiographs 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals [see WARNINGS] ... Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. The prescribed dose of ibuprofen 400 mg TIDPRN for 30 days is within the recommended dosage for mild to moderate pain. The patient should not exceed the maximum daily dose of 3200 mg.
From the Research
Patient Treatment Plan
- The patient is a 36-year-old male with left wrist pain, and the x-ray shows no arthritic or post-traumatic bony changes 2.
- The patient reports improvement since changing the way he watches TV, and a wrist brace is prescribed for support, along with ibuprofen 400 mg TIDPRN for 30 days 3.
- The patient is scheduled for a follow-up in 60 days.
Wrist and Hand Tendinopathies
- Tendinopathies in the hand and wrist are common, and diagnosis, nonoperative and operative treatment, and postoperative recommendations are crucial for effective management 4.
- Physical modalities, such as laser therapy and therapeutic ultrasound, are effective for De Quervain tenosynovitis, while extracorporeal shock wave therapy (ESWT) is efficient and safe for Dupuytren disease 2.
- ESWT is also frequently used for functional improvement and pain control in trigger finger 2.
Treatment Options
- Conservative treatment options, such as activity modification, splints, and injections, are often used as first-line treatment for tendinopathies 3.
- Surgery may be necessary after a 3- to 6-month trial of nonoperative treatment, involving decompression of the involved tendons and debridement of any inflammatory tissue 3.
- Patient understanding of their treatment plan is crucial for effective management, and factors such as empathy, quality of communication, and educational background can impact patient understanding 5.