Differential Diagnosis for Dorsal Hand and Wrist Pain Post-ORIF for Scaphoid Fracture

Single Most Likely Diagnosis

• Hardware irritation or prominence: This is a common issue after orthopedic surgeries, including ORIF (Open Reduction Internal Fixation) for scaphoid fractures. The hardware used (e.g., screws, plates) can irritate the surrounding tissues or become prominent, causing pain, especially over the dorsal aspect of the hand and wrist where the hardware is often placed.

Other Likely Diagnoses

• Adhesive capsulitis (Stiffness): Postoperative stiffness is common after wrist surgeries. It can lead to pain and limited range of motion, which might be perceived as pain over the dorsal aspect of the hand and wrist.
• Tendonitis: Tendons around the wrist can become inflamed due to overuse or irritation from the surgical hardware, leading to pain.
• Scaphoid nonunion or malunion: Despite ORIF, there's a risk of the scaphoid fracture not healing properly (nonunion) or healing in an incorrect position (malunion), which can cause ongoing pain.

Do Not Miss Diagnoses

• Infection: Postoperative infection is a serious complication that requires prompt diagnosis and treatment. Signs might include increased redness, swelling, warmth, or purulent discharge, but sometimes the presentation can be more subtle, with pain being the primary symptom.
• Compartment syndrome: Although less common after ORIF for scaphoid fractures, compartment syndrome is a medical emergency that can occur if there's increased pressure within the compartments of the wrist, leading to nerve and muscle damage.
• Nerve injury or neuropathy: Direct injury to nerves during surgery or compression from swelling or hardware can cause significant pain and neurological symptoms.

Rare Diagnoses

• Complex regional pain syndrome (CRPS): A rare condition characterized by intense burning or aching pain in the hands or feet after an injury or trauma, which can be the scaphoid fracture or the surgery itself.
• Ganglion cyst: A lump or mass that can develop on the wrist, which might cause pain if it presses on nerves or joints.
• Osteonecrosis of the scaphoid: The blood supply to the scaphoid bone can be compromised, leading to the death of bone tissue, which is a rare but serious complication of scaphoid fractures.

Each of these diagnoses has different management options, ranging from conservative treatments like physical therapy and medication to further surgical interventions. Accurate diagnosis through a combination of clinical evaluation, imaging studies, and sometimes diagnostic injections is crucial for guiding the appropriate management strategy.