Document Detail


Evaluation and diagnosis of wrist pain: a case-based approach.
MedLine Citation:
PMID:  23668446     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with wrist pain commonly present with an acute injury or spontaneous onset of pain without a definite traumatic event. A fall onto an outstretched hand can lead to a scaphoid fracture, which is the most commonly fractured carpal bone. Conventional radiography alone can miss up to 30 percent of scaphoid fractures. Specialized views (e.g., posteroanterior in ulnar deviation, pronated oblique) and repeat radiography in 10 to 14 days can improve sensitivity for scaphoid fractures. If a suspected scaphoid fracture cannot be confirmed with plain radiography, a bone scan or magnetic resonance imaging can be used. Subacute or chronic wrist pain usually develops gradually with or without a prior traumatic event. In these cases, the differential diagnosis is wide and includes tendinopathy and nerve entrapment. Overuse of the muscles of the forearm and wrist may lead to tendinopathy. Radial pain involving mostly the first extensor compartment is commonly de Quervain tenosynovitis. The diagnosis is based on history and examination findings of a positive Finkelstein test and a negative grind test. Nerve entrapment at the wrist presents with pain and also with sensory and sometimes motor symptoms. In ulnar neuropathies of the wrist, the typical presentation is wrist discomfort with sensory changes in the fourth and fifth digits. Activities that involve repetitive or prolonged wrist extension, such as cycling, karate, and baseball (specifically catchers), may increase the risk of ulnar neuropathy. Electrodiagnostic tests identify the area of nerve entrapment and the extent of the pathology.
Authors:
Ramsey Shehab; Mark H Mirabelli
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American family physician     Volume:  87     ISSN:  1532-0650     ISO Abbreviation:  Am Fam Physician     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-05-14     Completed Date:  2013-07-12     Revised Date:  2013-12-04    
Medline Journal Info:
Nlm Unique ID:  1272646     Medline TA:  Am Fam Physician     Country:  United States    
Other Details:
Languages:  eng     Pagination:  568-73     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 American Academy of Family Physicians.
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MeSH Terms
Descriptor/Qualifier:
Accidental Falls
Adult
De Quervain Disease* / complications,  diagnosis,  physiopathology
Diagnosis, Differential
Electrodiagnosis / methods
Female
Fractures, Bone* / complications,  physiopathology,  radiography
Humans
Magnetic Resonance Imaging / methods
Male
Medical History Taking / methods
Pain* / diagnosis,  etiology,  physiopathology
Physical Examination / methods
Scaphoid Bone / injuries*
Symptom Assessment / methods
Tomography, X-Ray Computed / methods
Ulnar Neuropathies* / complications,  diagnosis,  physiopathology
Wrist / physiopathology*
Comments/Corrections
Erratum In:
Am Fam Physician. 2013 Oct 1;88(7):427

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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