Differential Diagnosis for Wrist and Forearm Pain
- Single most likely diagnosis
- Tendinitis: The patient's symptoms of mild pain, intermittent swelling, and tenderness to touch, particularly with twisting motions of the wrist, are consistent with tendinitis. The lack of significant improvement with ibuprofen and the specific activities that exacerbate the discomfort (e.g., opening a contact case or grasping an air gun) also support this diagnosis.
- Other Likely diagnoses
- Repetitive Strain Injury (RSI): Given the patient's occupation and the activities that worsen the pain, RSI is a plausible diagnosis. The symptoms of pain and swelling with specific movements are consistent with this condition.
- Ganglion Cyst: Although the patient does not report a visible lump, ganglion cysts can cause intermittent pain and swelling, especially with certain wrist movements.
- Wrist Sprain: Despite the patient's denial of injury, a minor sprain could have occurred, leading to the reported symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Osteomyelitis: Although the patient denies fever and discoloration, osteomyelitis (bone infection) is a serious condition that requires prompt diagnosis and treatment. The presence of pain, swelling, and tenderness could be indicative of an underlying infection.
- Compartment Syndrome: This is a rare but potentially devastating condition that can cause pain, swelling, and tenderness, especially with activity. It is essential to consider this diagnosis, even if it seems unlikely.
- Rare diagnoses
- Kienbock's Disease: A rare condition characterized by avascular necrosis of the lunate bone, which could cause wrist pain and swelling.
- Gout or Pseudogout: Although less common in the wrist, these conditions can cause sudden, severe pain and swelling, often accompanied by redness and warmth.
- Wrist Tumor: A rare possibility, but it is essential to consider the possibility of a benign or malignant tumor, especially if the symptoms persist or worsen over time.