Evaluation of the adult with subacute or chronic 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 overuse syndromes, and chronic wrist pain is a common presenting complaint in primary care and sports medicine clinics. Such pain may result from the residual effects of past trauma or nontraumatic conditions. Generally, we define chronic conditions are those that have been present for longer than three months, acute conditions as those present for less than two weeks, and subacute conditions as those present for two weeks to three months.
The common causes of chronic wrist pain and an approach to diagnosing these problems is provided here. Acute wrist pain, wrist anatomy and biomechanics, and more detailed discussions of specific wrist problems are reviewed separately. (See "Evaluation of the adult with acute 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 (see "Evaluation of the adult with acute wrist pain")
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- ANATOMY AND BIOMECHANICS
- DIAGNOSTIC CATEGORIES AND OVERALL APPROACH
- PHYSICAL EXAMINATION
- Range of motion
- Special tests
- DIFFERENTIAL DIAGNOSIS BY REGIONS OF THE WRIST
- Ulnar sided wrist pain
- - Extensor carpi ulnaris tendinopathy and subluxation
- - Triangular fibrocartilage complex injury
- Radial sided wrist pain
- - Scaphoid fracture
- - Scapholunate instability
- - de Quervain’s tenosynovitis
- - Carpal metacarpal osteoarthritis
- - Radiocarpal arthritis
- Volar sided wrist pain
- - Carpal tunnel syndrome
- - Hook of the hamate fracture
- - Ulnar neuropathy (Guyon’s canal syndrome)
- Dorsal sided wrist pain
- - Ganglion cyst
- - Carpal boss
- - Kienböck's disease of the lunate
- - Intersection syndrome
- Approach to imaging
- Plain radiographs
- Computed tomography
- Magnetic resonance imaging
- Diagnostic ultrasound
- 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
- SUMMARY AND RECOMMENDATIONS