Wrist&hand Pain
From Anvita Health Wiki
Contents |
Etiology
- (Differential diagnosis)
- tendonitis
- de Quervain's tenosynovitis
- wrist/finger extensor tendonitis
- wrist/finger flexor tendonitis
- intersection syndrome
- peripheral nerve entrapment
-
- carpal tunnel syndrome ( motor &/or sensory)
- pronator teres entrapment - generally sensory involvement alone
- anterior interosseous syndrome ( motor)
- ulnar nerve entrapment at the wrist ( Guyon's canal) ( motor &/or sensory)
- ulnar nerve entrapment at the elbow
- ligament injury to the carpal bones
- triangular fibrocartilagenous complex
- radioulnar ligament sprain
- carpometacarpal sprain
- carpal navicular fracture
- scaphoid fracture
- distal radius fracture
- ulnar styloid fracture
- other carpal fractures
Clinical-manifestations
- general
- atrophy of the thenar eminence suggests involvement of the median nerve
- atrophy of the hypothenar eminence suggests involvement of the ulnar nerve
- Tinel's sign
- Phalen's sign
- positive Finkelstein's test
- squeaking with movement suggests tendonitis
- popping or clicking with movement suggests cartilage tear of ligament laxity
- grinding sensation with movement suggests arthritis
- paresthesia, especially at night suggests nerve entrapment
Laboratory
Diagnostic-procedures
Radiology
- plain radiographs: may need to repeat in 2-8 weeks to rule out navicular or other carpal fractures
- magnetic resonance imaging ( MRI)
- bone scan
- arthrography
Management
- relative rest, short term immobilization may be helpful
- pharmacologic agents a non-steroidal anti-inflammatory agents for 7-10 days
- corticosteroid injections: short-term relief, but may cause tissue degeneration
- ice, heat
- high- voltage galvanic stimulation, iontophoresis, & phonophoresis ( ultrasound)
- physical therapy with improvement in pain
- surgery
- failure of 3-6 months rehabilitation
- persistent pain at rest of with activities of daily living
- unacceptable quality of life
More General Terms
Additional Terms
- anterior interosseous syndrome
- carpal tunnel syndrome (median neuropathy)
- de Quervain's tenosynovitis (stenosing tenosynovitis)
- Finkelstein's test
- intersection syndrome
- Phalen's sign
- scaphoid fracture
- Tinel's sign
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 742-44
- Medical Knowledge Self Assessment Program (MKSAP) 14, 15, American College of Physicians, Philadelphia 2006, 2009
- National Guideline Clearinghouse ACR Appropriateness Criteria for chronic wrist pain ngc-guideline: [1]
- Hand, wrist, and forearm disorders, not including carpal tunnel syndrome. American College of Occupational and Environmental Medicine ngc-guideline: [2]
