Differential Diagnosis for Wrist Pain in a 17-year-old Boy

Single Most Likely Diagnosis

• Fracture of the scaphoid: This is the most likely diagnosis given the mechanism of injury (fall onto an outstretched hand) and the location of pain (radial portion of the wrist). The scaphoid bone is the most commonly fractured carpal bone, and it is often injured with this type of fall.

Other Likely Diagnoses

• Fracture of the distal radius: This is another common injury that can occur from a fall onto an outstretched hand. The patient's preference for extension and radial deviation could be consistent with this diagnosis.
• De Quervain tenosynovitis: Although less likely given the acute trauma, de Quervain tenosynovitis (inflammation of the tendons on the thumb side of the wrist) could be considered, especially if the patient had been experiencing repetitive strain or overuse prior to the fall.

Do Not Miss Diagnoses

• Dislocation or fracture of other carpal bones: While less common, dislocations or fractures of other carpal bones (such as the capitate) could have serious consequences if missed, including chronic pain, arthritis, and decreased wrist function.
• Growth plate injury (if applicable): In pediatric patients, it's crucial to consider the potential for growth plate injuries, which could affect bone development if not properly addressed.

Rare Diagnoses

• Fracture of the proximal first metacarpal: This type of fracture is less common in the context of a fall onto an outstretched hand and would more typically be associated with direct trauma to the thumb or a different mechanism of injury.
• Other rare carpal bone fractures or dislocations: Fractures or dislocations of other carpal bones are less common and might not be the first consideration but should be kept in mind during a thorough evaluation.