Differential Diagnosis for Wrist Pain

Single Most Likely Diagnosis

• Scapholunate Ligament Sprain or Tear: This is a common injury in rock climbing due to the repetitive strain and twisting motions involved. The scapholunate ligament is crucial for wrist stability, and its injury can lead to chronic pain and dysfunction, especially with rotational movements.

Other Likely Diagnoses

• Tendinitis (e.g., De Quervain's Tenosynovitis): Inflammation of the tendons around the wrist, which can be exacerbated by activities like rock climbing and driving. This condition causes pain and tenderness, particularly with thumb movement and wrist rotation.
• Wrist Ganglion Cyst: A common benign lump that can develop on the wrist, often related to repetitive strain or injury. It can cause pain, especially if it compresses nearby nerves or tendons.
• Triangular Fibrocartilage Complex (TFCC) Injury: The TFCC is a ligamentous structure that supports the wrist. An injury to this area, common in sports involving wrist rotation, can lead to chronic pain and instability.

Do Not Miss Diagnoses

• Scaphoid Fracture: Although less likely if the pain has been chronic without significant trauma, a scaphoid fracture is a critical diagnosis not to miss due to its potential for complications like avascular necrosis if not properly treated.
• Osteonecrosis (Avascular Necrosis): This condition involves the death of bone tissue due to a lack of blood supply. It can occur in the wrist bones, especially after a fracture or repetitive microtrauma, and requires early diagnosis to prevent further damage.
• Infectious or Inflammatory Arthritis: Conditions like septic arthritis or rheumatoid arthritis can cause chronic wrist pain and must be considered, especially if there are systemic symptoms or signs of infection.

Rare Diagnoses

• Kienböck's Disease: A rare condition characterized by the collapse of the lunate bone in the wrist due to a loss of blood supply. It can cause chronic wrist pain and is more common in young adults.
• Pisotriquetral Joint Disorders: Problems with the pisotriquetral joint, such as arthritis or instability, can cause ulnar-sided wrist pain but are less common than other causes of wrist pain.