2026 Workshop Handout Bundle-W112J - Assessment of Hand and Wrist Pain That Is Not CTS

W112J - Assessment of Hand and Wrist Pain That Is Not CTS - Dutton Meiling

Pdf Summary

This workshop reviews common causes of hand, wrist, and elbow pain that can mimic nerve entrapment syndromes. Organizing the differential by pain location can guide examination and ultrasound assessment.

<strong>Volar-radial pain</strong> may result from thumb carpometacarpal arthritis, radiocarpal arthritis, or flexor carpi radialis (FCR) tendinitis. Thumb-base arthritis causes pain with pinching, gripping, or turning; a painful or crepitant grind test supports the diagnosis. Radiocarpal arthritis typically causes gradual wrist pain and joint tenderness. FCR tendinitis is associated with repetitive wrist flexion and pain on tendon palpation or resisted wrist flexion.

<strong>Dorsal-radial pain</strong> can reflect De Quervain tenosynovitis, proximal intersection syndrome, scapholunate ligament injury, or lateral epicondylosis. De Quervain’s causes pain with gripping or lifting and may be reproduced by the Finkelstein test. Intersection syndrome produces pain or crepitus several centimeters above the radial styloid. Scapholunate injury often follows forced wrist extension and causes pain under wrist loading; the Watson shift test may reproduce pain or a clunk. Lateral epicondylosis causes lateral elbow pain, often provoked by resisted wrist extension or supination.

<strong>Ulnar-sided pain</strong> may be due to extensor carpi ulnaris (ECU) tendinitis or instability, trigger finger, ulnar impaction syndrome, or elbow ulnar collateral ligament injury. ECU symptoms can include pain or snapping with resisted wrist extension. Trigger finger causes painful clicking, catching, or locking, commonly at the ring finger. Ulnar impaction pain worsens with forearm pronation, wrist ulnar deviation, or axial loading. Ulnar collateral ligament injury is common in throwing athletes and may cause medial elbow pain or instability.

Ultrasound can identify findings such as joint osteophytes, synovitis, tendon thickening or sheath fluid, ligament abnormalities, dynamic tendon subluxation, and widening under stress. Some suspected injuries, including ulnar impaction with associated bone edema or TFCC damage, may require MRI.

Keywords

hand pain

wrist pain

elbow pain

nerve entrapment

thumb carpometacarpal arthritis

De Quervain tenosynovitis

FCR tendinitis

scapholunate ligament injury

ulnar impaction syndrome

ultrasound assessment