Wrist Pain Differential Diagnosis

The following is a differential diagnosis for wrist pain, categorized for clarity and emphasis on critical conditions.

• Single most likely diagnosis

  • Tendinitis: This is often the most common cause of wrist pain, especially in individuals who perform repetitive motions with their wrists, such as computer users or athletes. Tendinitis involves inflammation of the tendons, which can cause pain and stiffness.

• Other Likely diagnoses

  • Carpal Tunnel Syndrome: A condition that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. Symptoms include numbness, tingling, and pain in the hand and wrist.
  • Ganglion Cyst: A noncancerous lump that forms on the wrist, often attached to a tendon or joint. It can cause pain, especially if it presses on a nerve.
  • Wrist Sprain: An injury to the ligaments in the wrist, which can occur from a fall onto an outstretched hand or from sudden twisting of the wrist.
  • Osteoarthritis: A type of arthritis that can affect the wrist, causing pain, stiffness, and limited mobility.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)

  • Infectious Arthritis: A condition where the joint space becomes infected, leading to severe pain, swelling, and potential destruction of the joint if not promptly treated.
  • Fracture: Especially a scaphoid fracture, which can be subtle and might not be immediately apparent on X-rays. Missing this diagnosis can lead to complications like avascular necrosis.
  • Compartment Syndrome: A condition where increased pressure within a muscle compartment leads to insufficient blood supply to the tissues inside the compartment, which can cause severe pain and potentially lead to permanent damage if not treated promptly.

• Rare diagnoses

  • Kienböck's Disease: A rare condition where the blood supply to the lunate bone in the wrist is disrupted, leading to the death of the bone tissue (avascular necrosis).
  • Pisotriquetral Joint Disorders: Problems with the joint between the pisiform and triquetrum bones, which can cause pain on the ulnar side of the wrist.
  • Gout or Pseudogout: Forms of arthritis that can affect the wrist, causing sudden, severe attacks of pain, swelling, redness, and tenderness.

Each of these diagnoses has distinct characteristics and requires specific management strategies. A thorough clinical evaluation, including history, physical examination, and sometimes imaging studies, is necessary to determine the underlying cause of wrist pain.