Differential Diagnosis for Wrist Pain

The patient's wrist pain, which flared up after pushups and then again after crochet, suggests a condition that is exacerbated by repetitive motion or strain. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Tendinitis (specifically, wrist extensor or flexor tendinitis): This condition is likely due to the repetitive strain from pushups and crochet, which would irritate the tendons around the wrist, leading to pain and inflammation. The improvement with rest and flare-up with activity supports this diagnosis.

• Other Likely Diagnoses

  • Wrist sprain: A sprain could occur from the pushups, especially if there was an awkward landing or excessive strain on the wrist. The pain could improve with rest but return with activities like crochet that involve gripping and twisting motions.
  • Carpal tunnel syndrome: Although more commonly associated with numbness and tingling, carpal tunnel syndrome can also cause wrist pain, especially with activities that involve flexion of the wrist, like crochet.
  • Ganglion cyst: A ganglion cyst is a lump under the skin that occurs near joints or tendons, and it can cause pain, especially if it presses on a nerve. Activities that increase pressure on the wrist could exacerbate symptoms.

• Do Not Miss Diagnoses

  • Fracture (including scaphoid fracture): Although less likely given the improvement with rest, a fracture (especially of the scaphoid bone) could present with similar symptoms. Missing a fracture could lead to serious complications, such as nonunion or avascular necrosis.
  • Infectious tenosynovitis: An infection within the tendon sheath, which could be introduced through a puncture wound or spread from another site. This condition requires prompt antibiotic treatment and possibly surgical intervention.
  • Gout or pseudogout: These conditions involve the deposition of crystals within the joints and can cause sudden, severe pain. Although less common in the wrist, they should be considered, especially if there's a history of similar episodes in other joints.

• Rare Diagnoses

  • Kienböck's disease (avascular necrosis of the lunate bone): A rare condition where the blood supply to the lunate bone in the wrist is interrupted, leading to its necrosis. It could cause chronic wrist pain.
  • Osteonecrosis of other carpal bones: Similar to Kienböck's disease but affecting different bones in the wrist.
  • Tumor (benign or malignant): Although extremely rare, a tumor within the wrist could cause pain, especially if it presses on nerves or interferes with tendon function.

Each of these diagnoses has a different set of implications for treatment and prognosis, highlighting the importance of a thorough evaluation to determine the underlying cause of the wrist pain.