WRIST PAIN - Common Patterns

1)      Carpal tunnel syndrome – repetitive occupational injury pattern indicating wrist trauma, hypothyroidism, pregnancy, diabetes,

2)      De Quervains’s tenosynovitis – point tenderness at the distal radial styloid, positive Finkelstein’s test,

3)      De Quervains’s tenosynovitis – RSI variant – pinching or grasping while the wrist is involved in radial and ulnar deviation movements,

4)      Cervical referred pain from cervical radiculopathy, thoracic outlet syndrome

5)      Radioulnar joint instability – pain at wrist, point tenderness over the radioulnar joint, grind test positive (while rotating the forearm compress distal ends of radius and ulnar at the joint),

6)      Arthritis – rheumatoid arthritis, and viral polyarthritis may initially affect wrist joint

7)      Ulnar nerve entrapment at Guyon’s canal – pain, paresthesiae, numbness in the lateral aspects of the ring and little fingers of the hand and weakness of the little finger, point tenderness at the Guyon’s tunnel, Tinel’s positive at the same site, sensory loss and weakness of abduction of the little finger of the hand,

8)      Hypothenar Hammer Syndrome – repeated trauma to the superficial palmar arch, blanching, pins and needles, coldness, pain, especially on exposure to cold, Allen’s test positive – clench the fist to blanch the palmar skin.  Occlude the radial artery at the wrist manually and then unclench the fist.  If the blood return is slower than normal the test is positive.

9)      Myofascial pain syndrome - palmar aspect of the wrist in opponents pollicis MFPS, palmar aspect pain spreading up and down in flexor carpi radialis and ulnaris palmar aspect pain spreading to forearm and to hypothenar eminence in pronator teres MFPS, anterior and posterior aspects of wrist pain starting from posterior chest wall scapular area spreading to the anterior shoulder, posteromedial aspect of arm in subscapularis MFPS.  See notes under myofascial pain syndrome for diagnostic criteria and treatment.

» SYMPTOM, SIGNS, SYNDROMES GLOSSARY