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
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
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
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- 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