Differential Diagnosis for Wrist Pain
Single Most Likely Diagnosis
- Tendinitis or Tenosynovitis: Given the presence of minor radial soft tissue swelling on MRI without evidence of fracture, osteonecrosis, or internal derangement, inflammation of the tendons or their surrounding sheaths is a plausible cause for the patient's continued wrist pain.
Other Likely Diagnoses
- Wrist Sprain: Although the MRI does not show specific internal derangement, a sprain could still be present, especially if the ligaments are not significantly damaged but still inflamed or partially torn.
- Repetitive Strain Injury: This could lead to chronic inflammation and pain, consistent with the patient's symptoms, especially if the patient has recently increased activity or has a job that involves repetitive wrist movements.
- Ganglion Cyst: While the MRI might not have identified a cyst, these are common in the wrist and can cause pain and swelling, fitting the patient's presentation.
Do Not Miss Diagnoses
- Scaphoid Fracture with Negative Initial Imaging: Although the MRI is negative for fracture, scaphoid fractures can sometimes be missed on initial imaging. A scaphoid fracture is a critical diagnosis not to miss due to the risk of avascular necrosis and long-term disability if not properly treated.
- Infectious Arthritis: Although less likely, infectious arthritis could present with similar symptoms and would require urgent diagnosis and treatment to prevent joint destruction.
- Osteoid Osteoma: A small, benign bone tumor that could cause persistent pain and might not be visible on all MRI sequences, especially if small.
Rare Diagnoses
- Kienböck's Disease (Avascular Necrosis of the Lunate): While the MRI is negative for osteonecrosis, this condition can sometimes be subtle on initial imaging. It's a rare condition but important to consider in the differential for chronic wrist pain.
- Gout or Pseudogout: These conditions can cause acute or chronic wrist pain and might not always present with classic signs of arthritis, making them rare but possible considerations in the differential diagnosis.
- Tumor (Benign or Malignant): Although very rare, a tumor in the wrist could cause chronic pain and swelling. The absence of specific findings on MRI does not entirely rule out this possibility, especially if the tumor is small or of a type not easily visible on standard MRI sequences.