Differential Diagnosis for Wrist and Thumb Pain

Single Most Likely Diagnosis

• Overuse Injury or Repetitive Strain Injury: The patient's symptoms of wrist and thumb pain, exacerbated by activities such as lifting, writing, and playing hockey, suggest an overuse injury. The lack of trauma history and the gradual onset of pain also support this diagnosis.

Other Likely Diagnoses

• Tendinitis: Inflammation of the tendons in the wrist and thumb could cause pain, especially with activities that involve gripping or twisting.
• Ganglion Cyst: A common condition that can cause wrist pain, especially if the cyst is pressing on a nerve.
• De Quervain's Tenosynovitis: Inflammation of the tendons on the thumb side of the wrist, which can cause pain and tenderness, especially with activities that involve gripping or twisting.

Do Not Miss Diagnoses

• Scaphoid Fracture: Although the patient denies any trauma history, a scaphoid fracture can occur with minimal trauma and may not be immediately apparent. Missing this diagnosis could lead to complications such as avascular necrosis.
• Osteonecrosis: A condition that can cause pain and disability if not treated promptly.
• Infection (e.g., Osteomyelitis or Septic Arthritis): Although unlikely, an infection in the wrist or thumb could have serious consequences if not promptly diagnosed and treated.

Rare Diagnoses

• Kienbock's Disease: A rare condition that affects the blood supply to the lunate bone in the wrist, causing pain and stiffness.
• Gout or Pseudogout: Although rare in a 16-year-old, these conditions can cause sudden, severe pain and swelling in the wrist or thumb.
• Tumor (e.g., Giant Cell Tumor or Osteochondroma): Although extremely rare, a tumor in the wrist or thumb could cause pain and other symptoms.