Differential Diagnosis for Wrist/Arm Pain Worse with Supination

• Single most likely diagnosis
  • Bicipital Tendinitis: This condition involves inflammation of the tendon that attaches the biceps muscle to the shoulder or elbow, and it can cause pain in the bicep area that worsens with supination due to the increased tension on the tendon during this movement.
• Other Likely diagnoses
  • Radial Head Fracture or Radial Head Subluxation (Nursemaid's Elbow): Although more common in children, these conditions can cause pain that worsens with supination due to the mechanics of the elbow joint and the involvement of the radial head.
  • Lateral Epicondylitis (Tennis Elbow): While primarily associated with extension of the wrist against resistance, some cases may experience increased pain with supination, especially if the condition has led to inflammation or irritation of nearby structures.
• Do Not Miss diagnoses
  • Compartment Syndrome: A serious condition that involves increased pressure within a muscle compartment, which can lead to nerve and muscle damage. It may present with pain on movement, including supination, and is critical to diagnose early to prevent long-term damage.
  • Brachial Artery Injury or Thrombosis: Although less common, any condition affecting the brachial artery could potentially cause arm pain that worsens with certain movements, including supination, due to altered blood flow.
• Rare diagnoses
  • Osteochondritis Dissecans of the Capitellum: A rare condition in the elbow joint where a piece of cartilage and bone becomes damaged, potentially causing pain with movement, including supination, especially in young athletes.
  • Entrapment of the Posterior Interosseous Nerve: A rare condition where the nerve that controls wrist and finger extension becomes compressed, potentially causing pain and weakness that could worsen with supination due to the altered mechanics of the forearm and wrist.