Differential Diagnosis for Dorsal Central Wrist Pain
Single Most Likely Diagnosis
- Wrist Extensor Tendinopathy: This condition, often related to overuse or repetitive strain, is a common cause of dorsal wrist pain, especially when exacerbated by activities like pushups that involve wrist extension.
Other Likely Diagnoses
- Ganglion Cyst: A common benign lump that can cause pain and discomfort on the dorsal aspect of the wrist, especially if it compresses nearby nerves or tendons.
- Wrist Sprain: An injury to the ligaments surrounding the wrist joint can cause pain, especially on the dorsal side, and may be exacerbated by activities that put stress on these ligaments.
- Intersection Syndrome: This condition, characterized by inflammation of the tendons on the dorsal aspect of the wrist, can cause pain and swelling, particularly with activities that involve wrist extension.
Do Not Miss Diagnoses
- Scaphoid Fracture: Although less common, a fracture of the scaphoid bone in the wrist can cause dorsal wrist pain and must be considered, especially if there's a history of trauma, as missing this diagnosis can lead to complications like nonunion or avascular necrosis.
- Osteonecrosis of the Lunate (Kienböck's Disease): A rare condition where the blood supply to the lunate bone is disrupted, leading to its necrosis, which can cause chronic wrist pain.
- Infectious or Inflammatory Arthritis: Conditions like septic arthritis or rheumatoid arthritis can cause wrist pain and must be considered, especially if there are systemic symptoms or signs of infection.
Rare Diagnoses
- Gout or Pseudogout: Deposition of urate or pyrophosphate crystals within the wrist joint can cause acute or chronic pain and should be considered, especially in patients with a history of these conditions.
- Tumor (Benign or Malignant): Although rare, tumors of the wrist can cause chronic pain and should be considered if other diagnoses are ruled out and pain persists.
- Nerve Entrapment Syndromes: Conditions like radial nerve compression can cause pain and other symptoms on the dorsal aspect of the wrist and hand.