Evaluation of the adult with acute wrist pain
- Blake Reid Boggess, DO, FAAFP
Blake Reid Boggess, DO, FAAFP
- Associate Professor of Orthopedic Surgery
- Duke Sports Medicine Team Physician
- Duke University Medical Center
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Due to its location and anatomy, the wrist is susceptible to a range of injuries, and acute wrist pain is a common presenting complaint in primary care and sports medicine clinics. Such pain often results from trauma but may stem from nontraumatic conditions. Generally, we define acute conditions of the wrist as those present for less than two weeks, subacute conditions as those present for two weeks to three months, and chronic conditions are those that have been present for longer than three months.
This topic review will provide an overview to acute wrist pain or injury in the adult. Subacute and chronic causes of wrist pain and specific wrist injuries are discussed in detail separately. (See "Evaluation of the adult with subacute or chronic wrist pain" and "Overview of carpal fractures" and "Distal radius fractures in adults" and "Scaphoid fractures".)
ANATOMY AND BIOMECHANICS
The anatomy and biomechanics of the wrist are reviewed in detail separately. (See "Anatomy and basic biomechanics of the wrist".)
DIAGNOSTIC CATEGORIES AND OVERALL APPROACH
Using information from the history, key symptoms, and findings from the basic wrist examination, the clinician can usually select one of three common diagnostic categories that best fits the patient. The three major categories are:
●Acute wrist pain, either from trauma or associated with overuse
- Loeser JD, Bonica JD. Bonica's Management of Pain, 3rd ed, Lippincott Williams & Wilkins, Philadelphia 2001.
- Halikis MN, Taleisnik J. Soft-tissue injuries of the wrist. Clin Sports Med 1996; 15:235.
- Seitz WH, Papandrea RF. Fractures and dislocations of the wrist. In: Rockwood and Green's Fractures in Adults, Bucholz RW, Heckman JD (Eds), Lippincott Williams & Wilkins, Philadelphia 2002. p.749.
- Lichtman DM, Schneider JR, Swafford AR, Mack GR. Ulnar midcarpal instability-clinical and laboratory analysis. J Hand Surg Am 1981; 6:515.
- Daniels JM 2nd, Zook EG, Lynch JM. Hand and wrist injuries: Part I. Nonemergent evaluation. Am Fam Physician 2004; 69:1941.
- Ahn AK, Chang D, Plate AM. Triangular fibrocartilage complex tears: a review. Bull NYU Hosp Jt Dis 2006; 64:114.
- Topper SM, Wood MB, Ruby LK. Ulnar styloid impaction syndrome. J Hand Surg Am 1997; 22:699.
- Webb BG, Rettig LA. Gymnastic wrist injuries. Curr Sports Med Rep 2008; 7:289.
- Zahiri H, Zahiri CA, Ravari FK. Ulnar styloid impingement syndrome. Int Orthop 2010; 34:1233.
- Garcia-Elias, Marc. Carpal Instability. In: Green's Operative Hand Surgery, 6th ed, Wolfe, SW, Hotchkiss, RN, Pederson, WC, Kozin, SH. (Eds), Elsevier, Philadelphia 2011. Vol I, p.483.
- Schnetzler KA. Acute carpal tunnel syndrome. J Am Acad Orthop Surg 2008; 16:276.
- Rettig AC. Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist. Am J Sports Med 2003; 31:1038.
- Sawardeker PJ, Kindt KE, Baratz ME. Fracture-dislocations of the carpus: perilunate injury. Orthop Clin North Am 2013; 44:93.
- Stanbury SJ, Elfar JC. Perilunate dislocation and perilunate fracture-dislocation. J Am Acad Orthop Surg 2011; 19:554.
- Budoff JE. Treatment of acute lunate and perilunate dislocations. J Hand Surg Am 2008; 33:1424.
- Scalcione LR, Gimber LH, Ho AM, et al. Spectrum of carpal dislocations and fracture-dislocations: imaging and management. AJR Am J Roentgenol 2014; 203:541.
- Innes L, Strauch RJ. Systematic review of the treatment of Kienböck's disease in its early and late stages. J Hand Surg Am 2010; 35:713.
- Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur Vol 2010; 35:549.
- Schuind F, Eslami S, Ledoux P. Kienbock's disease. J Bone Joint Surg Br 2008; 90:133.
- Hanlon DP, Luellen JR. Intersection syndrome: a case report and review of the literature. J Emerg Med 1999; 17:969.
- Lee RP, Hatem SF, Recht MP. Extended MRI findings of intersection syndrome. Skeletal Radiol 2009; 38:157.
- Rettig AC. Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 2004; 32:262.
- Chen PJ, Liu AL. Concurrent flexor carpi radialis tendon rupture and closed distal radius fracture. BMJ Case Rep 2014; 2014.
- ANATOMY AND BIOMECHANICS
- DIAGNOSTIC CATEGORIES AND OVERALL APPROACH
- Acute wrist pain associated with trauma or overuse
- Chronic wrist pain
- Wrist pain not associated with trauma or overuse
- PHYSICAL EXAMINATION
- DIFFERENTIAL DIAGNOSIS BY REGIONS OF THE WRIST
- Ulnar sided wrist pain
- - Extensor carpi ulnaris tendinopathy and subluxation
- - Triangular fibrocartilage complex injury
- - Triquetral fracture
- - Ulnar styloid impaction syndrome
- Radial sided wrist pain
- - Scaphoid fracture
- - Scapholunate instability
- - Trapezium fracture
- - de Quervain’s tenosynovitis
- - Carpometacarpal osteoarthritis
- Volar sided wrist pain
- - Hook of the hamate fracture
- - Pisiform fracture
- - Carpal tunnel syndrome
- - Ulnar neuropathy (Guyon’s canal syndrome)
- Dorsal sided wrist pain
- - Wrist sprain
- - Distal radius fracture
- - Carpal fractures
- Capitate fracture
- Lunate fracture
- Trapezoid fracture
- - Perilunate and lunate dislocations
- - Ganglion cyst
- - Kienböck's disease of the lunate
- - Intersection syndrome
- Approach to imaging
- Additional ultrasound resources
- APPROACH TO DIAGNOSIS
- Determine whether cause is traumatic or nontraumatic
- Determine whether nontraumatic pain is from overuse or nerve compression
- Correlate history and location of symptoms and signs
- INDICATIONS FOR IMMEDIATE SURGICAL REFERRAL
- SUMMARY AND RECOMMENDATIONS