Chronic wrist pain: Diagnosis and management. Development and use of a new algorithm

Abstract

Objective - -Chronic wrist pain can be difficult to manage and the differential diagnosis is extensive. To provide guidelines for assessment of the painful wrist an algorithm was developed to encourage a structured approach to the diagnosis and management of these patients. Methods - A review of the literature on causes of chronic wrist pain was undertaken; history takings physical examination and imaging studies were evaluated systematically to determine which of the many potential conditions was the cause of the wrist pain. Chronic wrist pain was subdivided into pain of probable intraarticular or extra-articular origin. By means of this classification a clinical algorithm was developed to establish a diagnosis and its clinical usefulness was tested in a prospective study of 84 patients presenting to our outpatient clinic. Results - A definite diagnosis could be established in 59% (49 of 84) of the cases by careful history takings extensive physical examinations plain radiographs, ultrasound examination and bone scintigraphy. In 19% of the cases (16 of 84) a probable diagnosis was made resulting in a total figure 78% (65 of 84). Additional imaging studies (arthrography, magnetic resonance imaging and computed tomography) increased the definite diagnoses to 70% (59 of 84). Conclusion - The algorithm proved easy to use and by the use of careful history takings thorough physical examination and simple imaging techniques (ultrasonography and scintigraphy) a diagnosis was made in 78% of cases.