Differential Diagnosis for Bilateral Wrist Pain and Ulnar Nerve Distribution Paresthesia
- Single Most Likely Diagnosis + Cubital Tunnel Syndrome: This condition is characterized by compression of the ulnar nerve at the elbow, leading to symptoms such as numbness, tingling, and pain in the ulnar nerve distribution of the hand. Bilateral involvement could be due to repetitive strain or anatomical issues affecting both elbows.
- Other Likely Diagnoses + Carpal Tunnel Syndrome: Although it primarily affects the median nerve, carpal tunnel syndrome can sometimes cause symptoms that overlap with ulnar nerve distribution, especially if there's significant compression or if the patient has a variant anatomy. Bilateral carpal tunnel syndrome is common. + Ulnar Nerve Entrapment at the Wrist (Guyon's Canal Syndrome): This condition involves compression of the ulnar nerve as it passes through Guyon's canal at the wrist, leading to symptoms similar to those of cubital tunnel syndrome but originating from the wrist. + Thoracic Outlet Syndrome: This syndrome involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause pain in the shoulders and neck and paresthesia in the hands, including the ulnar distribution.
- Do Not Miss Diagnoses + Multiple Myeloma: Although rare, multiple myeloma can cause nerve compression symptoms due to vertebral body compression fractures or direct nerve infiltration. It's crucial to consider this diagnosis due to its severe implications. + Amyotrophic Lateral Sclerosis (ALS): ALS can present with bilateral upper limb symptoms, including paresthesia. Early diagnosis is critical for management. + Vitamin B12 Deficiency: This deficiency can cause neurological symptoms, including paresthesia in the hands and feet. It's essential to diagnose and treat promptly to prevent irreversible nerve damage.
- Rare Diagnoses + Sarcoidosis: This autoimmune disease can cause nerve compression and neuropathy, including symptoms in the ulnar nerve distribution, though it's a less common presentation. + Leprosy (Hansen's Disease): Leprosy can cause peripheral neuropathy, including ulnar nerve symptoms, but it's rare in many parts of the world and typically associated with other systemic symptoms. + Tumor or Cyst Compressing the Ulnar Nerve: Rarely, a tumor or cyst can compress the ulnar nerve at any point along its course, leading to the described symptoms.