Differential Diagnosis for Wrist Pain

The patient presents with pain, tenderness, and burning sensations at the proximal wrist near the extensor digitorum on the posterior side of the forearm. Based on these symptoms, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Tennis Elbow (Lateral Epicondylitis): This condition is characterized by pain and tenderness on the lateral (outer) aspect of the elbow, which can radiate to the proximal wrist. It is often associated with activities that involve repetitive wrist extension, such as tennis, hence the name. The proximity of the pain to the extensor digitorum and its location on the posterior side of the forearm supports this diagnosis.

• Other Likely Diagnoses

  • Extensor Tendinitis: Inflammation of the tendons that extend the wrist, which could cause pain and tenderness in the area described.
  • Radial Nerve Compression: Compression of the radial nerve can cause pain, numbness, and tingling in the back of the hand or the thumb side of the hand, which might be perceived as wrist pain.
  • Wrist Sprain: A sprain of the wrist can cause pain and tenderness, especially if the injury involves the ligaments on the posterior side of the wrist.

• Do Not Miss Diagnoses

  • Gout: Although less common in the wrist, gout can cause sudden, severe pain and tenderness, often accompanied by redness and swelling. Missing this diagnosis could lead to prolonged suffering and potential joint damage.
  • Infectious Arthritis: Bacterial or fungal infections within the joint can cause severe pain, swelling, and systemic symptoms like fever. Early diagnosis is crucial to prevent joint destruction and systemic complications.
  • Fracture: A fracture of the wrist or forearm bones could cause pain and tenderness, especially if it involves the area near the extensor digitorum. Missing a fracture could lead to improper healing and long-term disability.

• Rare Diagnoses

  • Ganglion Cyst: A lump or mass that forms on the wrist, which can cause pain if it presses on nearby nerves.
  • Kienbock's Disease: A rare condition where the blood supply to one of the bones in the wrist (the lunate) is interrupted, leading to pain and stiffness in the wrist.
  • Osteonecrosis: Death of bone tissue due to a lack of blood supply, which can occur in the wrist bones and cause pain and limited mobility.

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 patient's symptoms.