Template:Wrist Pain DDX: Difference between revisions

From WikiMSK

No edit summary
ย 
(5 intermediate revisions by the same user not shown)
Line 1: Line 1:
==Differential Diagnoses==
==Differential Diagnoses==
===Acute Wrist Pain===
===Acute Wrist Pain===
*Distal radius fracture (often intra-articular in the athlete)
*[[Distal Radius (Colles) Fractures|Distal radius fracture]] (often intra-articular in the athlete)
*Scaphoid fracture
*[[Scaphoid Fracture]]
*Wrist ligament sprain/tear (intercarpal, scapholunate, lunotriquetral)
*Wrist ligament sprain/tear (intercarpal, scapholunate, lunotriquetral)
*Fracture of hook of hamate
*Fracture of hook of hamate
Line 14: Line 14:
*Dorsal wrist pain - Scaphoid fracture, Scaphoid impaction syndrome, Fracture dislocation of carpus, Lunate fracture, Distal radius fracture, Scapholunate ligament tear, Kienbock's disease (acute onset), Lunotriquetralligament tear, Distal radioulnar joint injury, Carpometacarpal dislocation
*Dorsal wrist pain - Scaphoid fracture, Scaphoid impaction syndrome, Fracture dislocation of carpus, Lunate fracture, Distal radius fracture, Scapholunate ligament tear, Kienbock's disease (acute onset), Lunotriquetralligament tear, Distal radioulnar joint injury, Carpometacarpal dislocation
*Volar wrist pain - Carpal instability, Hook of hamate fracture
*Volar wrist pain - Carpal instability, Hook of hamate fracture


===Subacute Dorsal Wrist Pain===
===Subacute Dorsal Wrist Pain===
Line 53: Line 52:


===Subacute Radial Wrist Pain===
===Subacute Radial Wrist Pain===
*Scaphoid fracture (missed)
{{Subacute Radial Wrist Pain DDX}}
*Non-union of scaphoid fracture
ย 
*De Quervain's tenosynovitis
===Carpal Tunnel Syndrome===
*Scaphoid impaction syndrome
{{Carpal Tunnel Syndrome DDX}}
*Intersection syndrome
*Flexor carpi radialis tendinopathy
*Dorsal pole of lunate impingement on distal radius (gymnasts)
*Scapholunate dissociation

Latest revision as of 22:02, 11 March 2023

Differential Diagnoses

Acute Wrist Pain

  • Distal radius fracture (often intra-articular in the athlete)
  • Scaphoid Fracture
  • Wrist ligament sprain/tear (intercarpal, scapholunate, lunotriquetral)
  • Fracture of hook of hamate
  • Triangular fibrocartilage complex tear
  • Distal radioulnar joint instability
  • Scapholunate dissociation
  • Carpal dislocation
  • Anterior dislocation of lunate
  • Perilunar dislocation
  • Traumatic ulnar artery aneurysm or thrombosis (karate)
  • Dorsal wrist pain - Scaphoid fracture, Scaphoid impaction syndrome, Fracture dislocation of carpus, Lunate fracture, Distal radius fracture, Scapholunate ligament tear, Kienbock's disease (acute onset), Lunotriquetralligament tear, Distal radioulnar joint injury, Carpometacarpal dislocation
  • Volar wrist pain - Carpal instability, Hook of hamate fracture

Subacute Dorsal Wrist Pain

  • Ganglion
  • Intersection syndrome
  • Kienbock's disease
  • Dorsal pole of lunate and distal radius impingement (gymnasts)
  • Posterior interosseous nerve entrapment
  • Inflammatory arthropathy
  • Degenerative joint disease
  • Extensor carpi ulnaris tendinopathy
  • Extensor carpi ulnaris subluxation
  • Injuries to distal radial epiphysis (children)
  • Extensor pollicis longus impingement on Lister's tubercle (occasional rupture)

Subacute Volar Wrist Pain

  • Scaphoid aseptic necrosis
  • Stenosing tendinopathies
  • Flexor carpi ulnaris tendinopathy
  • Carpal tunnel syndrome
  • Ulnar tunnel syndrome
  • Pisotriquetral degenerative joint disease
  • Avascular necrosis of the capitate (weightlifters)
  • Extensor pollicis longus impingement/rupture (gymnasts)

Subacute Ulnar Wrist Pain

  • Triangular fibrocartilage complex tears
  • Ulnar Impaction syndrome
  • Distal radioulnar joint instability
  • Carpal instability
  • Scapholunate dissociation
  • Ulnar nerve compression (cyclists, golfers)
  • Flexor carpi ulnaris tendinopathy
  • Extensor carpi uinaris tendinopathy
  • Extensor carpi ulnaris subluxation
  • Distal radioulnar joint impaction syndromes (golfers)
  • Scaphoid impaction syndrome

Subacute Radial Wrist Pain

Carpal Tunnel Syndrome

  • Cervical radicular pain (C6 or C7): Neck pain, positive Spurlings test
  • First Carpometacarpal Joint Osteoarthritis : Painful thumb motion, positive grind test, radiographic findings
  • De Quervain Tendinopathy: Tenderness distal radial styloid
  • Polyneuropathy: History of diabetes mellitus, bilateral, lower extremity involvement.
  • Thoracic Outlet Syndrome: ulnar sided symptoms, positive EAST and ULTT.
  • Pronator teres syndrome (median nerve compression at the elbow): Forearm pain; sensory loss over the thenar eminence; weakness with thumb flexion, wrist extension, and forearm pronation
  • Ulnar neuropathy: Paresthesias of the ring and little fingers, positive Tinel sign and compression tests at the elbow or wrist (Guyon canal)
  • Radial neuropathy
  • Raynaud syndrome:Symptoms related to cold exposure, typical color changes
  • Vibration white finger:Use of vibratory hand power tools, symptoms of Raynaud phenomenon
  • Wrist osteoarthritis: painful wrist motion, radiographic findings
  • Inflammatory arthropathy
  • Peripheral nerve tumour
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis
  • Acute compression syndromes (eg, Saturday night palsy)