Differential Diagnosis for Wrist Discomfort
Single most likely diagnosis
- Tendinitis or Tenosynovitis: The patient's symptoms of wrist discomfort, pain on flexion, and mild swelling after handling heavy wood are consistent with an overuse injury to the tendons or their surrounding synovial sheaths. The use of a brace providing some relief also supports this diagnosis.
Other Likely diagnoses
- Strain or Sprain: The mechanism of injury (handling heavy wood) and the symptoms of pain, mild swelling, and mild tingling could also be indicative of a strain or sprain of the wrist ligaments or muscles.
- Ganglion Cyst: Although less common, a ganglion cyst could cause wrist discomfort, pain on flexion, and mild swelling, especially if it is compressing a nerve, leading to tingling sensations.
- Carpal Tunnel Syndrome: The symptoms of pain on flexion and mild tingling could suggest carpal tunnel syndrome, especially if the median nerve is compressed due to swelling or cysts within the carpal tunnel.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Fracture: Although the patient has adequate range of motion and only mild swelling, it is crucial not to miss a fracture, especially a scaphoid fracture, which can have subtle initial presentations but lead to serious complications like avascular necrosis if not promptly diagnosed and treated.
- Infection (e.g., Cellulitis or Abscess): Any signs of infection, such as increasing redness, warmth, swelling, or fever, should be promptly addressed to prevent serious complications.
- Nerve Compression or Neuropathy: Conditions that cause nerve compression or neuropathy, such as a severe carpal tunnel syndrome or other nerve entrapments, need to be identified to prevent long-term nerve damage.
Rare diagnoses
- Kienböck's Disease: A rare condition involving the collapse of the lunate bone in the wrist, which could cause wrist pain and stiffness, especially with activities involving heavy lifting or bending.
- Gout or Pseudogout: Although more commonly associated with joints like the big toe, gout or pseudogout could theoretically cause wrist pain, swelling, and discomfort, especially if there are urate or pyrophosphate crystals deposited in the wrist joint.
- Tumor (Benign or Malignant): A tumor in the wrist, although rare, could cause pain, swelling, and limited range of motion, and should be considered in the differential diagnosis, especially if the symptoms are persistent or worsening over time.