Differential Diagnosis for a 12-year-old Patient with Hand and Wrist Pain

Single Most Likely Diagnosis

• Growing Pains: This is a common condition in children and adolescents, characterized by recurrent pain in the legs, but can also occur in the hands and wrists. The patient's age and the fact that he is double-jointed, which may lead to increased mobility and stress on the joints, support this diagnosis. The absence of carpal tunnel syndrome on nerve tests also points towards considering other causes of pain such as growing pains.

Other Likely Diagnoses

• Overuse Injury: Given the patient's history of overuse on the computer, it's possible that the pain is due to repetitive strain or overuse, even if carpal tunnel syndrome was ruled out. This could include conditions like wrist tendinitis or strain.
• Hypermobility Syndrome: Being double-jointed can lead to joint instability and increased risk of injury, which might cause pain in the hands and wrists. This condition often presents with joint pain and history of joint laxity.
• Juvenile Idiopathic Arthritis (JIA): Although less common, JIA can present with joint pain and swelling in children. The absence of systemic symptoms or significant morning stiffness does not rule out this diagnosis entirely.

Do Not Miss Diagnoses

• Bone Tumors or Cysts: Although rare, bone tumors (such as osteosarcoma) or cysts (such as unicameral bone cysts) can cause pain in the hands and wrists. These conditions are critical to diagnose early due to their potential for serious complications.
• Infection: Osteomyelitis or septic arthritis can cause severe pain and have significant consequences if not treated promptly. While less likely, these conditions must be considered, especially if there's a history of trauma or fever.
• Neurological Conditions: Conditions affecting the nerves, such as brachial plexitis or neuropathies, could cause pain and must be considered, even if initial nerve tests for carpal tunnel were negative.

Rare Diagnoses

• Ehlers-Danlos Syndrome: A genetic disorder that affects the body's connective tissue and can cause hypermobile joints, skin hyperextensibility, and tissue fragility. While it could explain the patient's double-jointedness and pain, it's less common.
• Skeletal Dysplasias: Certain genetic conditions that affect bone growth and development could lead to joint pain and hypermobility. These are rare and often present with other systemic features.