Wrist Pain Differential Diagnoses

Landmarks

Dorsal Wrist Pain

A = Intersection syndrome

B = De Quervain’s tenosynovitis

C = Scaphoid fracture / Wartenbergs Syndrome (nerve entrapment)

D = Base of thumb arthritis

E = Ulnar collateral ligament injury

F = Carpal boss

G = Scapholunate ligament tear

H = Keinbock’s disease

I = Lunotriquetral ligament tear

J = DRUJ (distal radioulnar joint) arthritis / instability

K = Ulnar impaction / TFCC tear

L = ECU dislocation / tendonitis

Volar Wrist Pain

A = FCU tendonitis

B = Pisiotriquetral arthritis / Ulnar nerve entrapment / ulnar artery thrombosis

C = Hook of hamate fracture

D = Trigger finger

E = Base of thumb arthritis

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, Intersection Syndrome
• 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

• Scaphoid Fracture (missed)
• Non-union of scaphoid fracture
• De Quervain Tendinopathy
• Scaphoid impaction syndrome
• Intersection Syndrome
• Flexor carpi radialis tendinopathy
• Dorsal pole of lunate impingement on distal radius (gymnasts)
• Scapholunate dissociation
• First Carpometacarpal Joint Osteoarthritis
• Scaphotrapeziotrapezoid (STT) Joint Osteoarthritis
• Osteoarthritis of the radiocarpal joint
• Ganglia
• Radial sensory nerve entrapment in the forearm
• Crystal-induced arthritis
• C6 radicular syndrome

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)