Differential Diagnosis for Sharp Wrist Pain
Single Most Likely Diagnosis
- Scaphoid Fracture: This is a common injury that can occur from a fall onto an outstretched hand or, in this case, pushing up off a couch, which can put significant stress on the wrist. The inability to make a fist could be due to pain or swelling associated with the fracture.
Other Likely Diagnoses
- Wrist Sprain: A sprain could result from the same mechanism of injury and would also cause sharp pain and potentially limit the ability to make a fist due to pain and swelling.
- Triangular Fibrocartilage Complex (TFCC) Injury: The TFCC is a ligamentous structure in the wrist that can be injured with a sudden rotational force, such as pushing up from a couch. Symptoms can include wrist pain and limited mobility.
- Extensor or Flexor Tendon Injury: Direct trauma or sudden contraction of the muscles in the forearm could lead to tendon injuries, causing pain and difficulty moving the wrist or hand.
Do Not Miss Diagnoses
- Compartment Syndrome: Although less likely, compartment syndrome is a medical emergency that can result from increased pressure within the compartments of the forearm or hand, potentially leading to nerve and muscle damage. Severe pain, especially on passive stretch, and decreased mobility are key signs.
- Vascular Injury: Injury to the radial or ulnar arteries could occur from trauma and might present with pain, pallor, pulselessness, poikilothermia, paresthesias, and paralysis (the "6 Ps" of vascular injury).
Rare Diagnoses
- Ganglion Cyst Rupture: While ganglion cysts are common, their rupture is less so and could potentially cause sudden onset of pain, although it might not directly relate to the inability to make a fist.
- Kienböck's Disease (Avascular Necrosis of the Lunate): This condition involves the collapse of the lunate bone due to a lack of blood supply. It's rare and typically presents with chronic wrist pain, but an acute exacerbation could potentially mimic the symptoms described.