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
• 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)