2025 Workshop Handout Bundle-W112AS Hand Wrist pain not CTS

W112AS Hand Wrist pain not CTS - Dutton Meiling

Pdf Summary

This document provides a detailed overview of various causes of hand and wrist pain excluding Carpal Tunnel Syndrome, categorizing them based on symptom location: volar-radial, dorsal-radial, and ulnar regions.

<strong>Volar-Radial Pain (Median Neuropathy Mimics):</strong>  
- <em>Thumb Carpometacarpal (CMC) Osteoarthritis</em>: Common in middle-aged women; pain worsens with thumb use; diagnosed with CMC grind test and ultrasound showing osteophytes or joint effusion.  
- <em>Radiocarpal Arthritis</em>: Due to degeneration, trauma, or inflammation; presents as volar/dorsal wrist pain with joint tenderness; ultrasound reveals osteophytes and synovitis.  
- <em>Flexor Carpi Radialis Tendinitis</em>: Caused by repetitive wrist flexion; pain at volar radial wrist; ultrasound shows tendon thickening and surrounding fluid.

<strong>Dorsal-Radial Pain (Radial Neuropathy Mimics):</strong>  
- <em>De Quervain Tenosynovitis</em>: More common in women, linked to repetitive wrist movements; diagnosed via Finkelstein test and ultrasound showing tendon sheath fluid and retinaculum thickening.  
- <em>Proximal Intersection Syndrome</em>: Seen in athletes; pain and crepitus proximal to radial styloid; ultrasound shows tendon thickening and fluid at the intersection of tendons.  
- <em>Scapholunate Ligament Injury</em>: Acute or chronic injury with dorsoradial pain, tested by Watson shift test; ultrasound shows ligament thickening, tears, or interval widening.  
- <em>Lateral Epicondylosis</em>: Overuse injury causing lateral elbow pain; diagnosed by resisted wrist extension tests and ultrasound revealing tendon hypoechogenicity and hypervascularity.

<strong>Ulnar Hand/Wrist Pain (Ulnar Neuropathy Mimics):</strong>  
- <em>Extensor Carpi Ulnaris Tendinitis/Subluxation</em>: Common in racket sports; dorsal ulnar wrist pain with snapping; ultrasound detects fluid, thickening, and dynamic subluxation.  
- <em>Trigger Finger</em>: Inflammation at A1 pulley causing clicking or locking; ultrasound reveals pulley thickening.  
- <em>Ulnar Impaction Syndrome</em>: Long ulna causes impaction on carpal bones with pain on ulnar deviation; ultrasound and MRI may detect ulnar variance and TFCC injury.  
- <em>Ulnar Collateral Ligament Injury</em>: Frequent in throwing athletes; medial elbow pain relieved by milking maneuver; ultrasound shows ligament swelling and joint widening under stress.

Ultrasound is emphasized throughout as a key diagnostic tool for structural abnormalities and inflammation, complementing clinical examination for accurate diagnosis and management of non-carpal tunnel hand and wrist pain.

Keywords

hand pain

wrist pain

volar-radial pain

dorsal-radial pain

ulnar wrist pain

ultrasound diagnosis

median neuropathy mimics

radial neuropathy mimics

ulnar neuropathy mimics

non-carpal tunnel syndrome