Wrist pain- causes
Radial –scaphoid fracture most common carpal fractures fall on an outstretched hand with wrist dorsiflexed and radially deviated tenderness over the anatomical snuff box , dorsoradial aspect of the wrist or scaphoid tubercle , pain with axial pressure on the 1st metacarpal bone + wrist may be swollen proximal pole of the scaphoid is relatively avascular and at high risk of nonunion and avascular necrosis combination of snuffbox swelling can be missed initially on clinical & radiological examination further assessment with CT / MRI can be helpful
Scaphoid non union patient may not recall the traumatic event can present with persistent wrist pain or new onset wrist pain
First carpo-metacarpal thumb arthritis – 2nd most common jt involved in wrist OA after DIP jt pain and swelling at the base of thumb reduced pinch & grip strength
Other causes – Scapho- lunate instability -ligamentous injury due to disruption of the mechanical linkage between the scaphoid and lunate de Quervain’s disease other fractures as radial styloid , trapezium , base 1st MC, trapezoid post-trauma arthroses
Triangular fibrocartilage complex tear – frequent wrist injuries which involve the cartilaginous meniscus between the radius & ulna TFCC complex stabilises the wrist at the distal Rad-ul jt & ulnocarpal articulations pain over the ulnar aspect of the wrist with clicking when hyperpronating and supinating ( opening jars or doors ) point tenderness – in the hollow between the pisiform , the flexor carpi ulnaris and ulnar styloid.
Distal radioulnar jt instability instability can happen due to distal radius fracture malunion , ulnar styloid fracture malunion , DRUJ dislocation
Extensor carpi ulnaris pathology external carpi ulnaris tendinitis ECU subluxation ( often sports related injury )
Volar aspect carpal tunnel syndrome ulnar neuropathy (Guyon’s canal synd ) fracture ( hamate , pisiform )
Dorsal aspect – wrist sprain fracture ( distal radius , capitate , lunate , trapezoid ) dislocations ( perilunate , lunate ) ganglion cyst Kienböck disease ( avascular necrosis of lunate ) Intersection syndrome
Diffuse – osteoarthritis , inflammatory arthritis ( rh arthritis , gout ) SLE involving the wrist OA can also be secondary to pre-existing damage to the wrist jt as fractures , ligamentous injuries or Kienbock’s disease.
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