An approach to the diagnosis of chronic wrist pain

A clinical algorithm was developed to help to establish a diagnosis in patients with chronic wrist pain. The accuracy of the algorithm was examined in a prospective blind study of 40 patients presenting to the Hand Unit with undiagnosed wrist pain and compared with the later findings at arthroscopy, which were believed to be as accurate as currently possible. Using simple examination techniques and conventional radiographs, an accurate diagnosis was made in 80% of cases. Examination techniques including the scapholunate shear test and the presence of local tenderness or pseudostability were found to be particularly accurate.