Evaluation of the patient presenting with a painful wrist

Wrist pain secondary to injury or disease is a common cause of morbidity and disability. The results of treatment are influenced strongly by promptly determining a correct diagnosis. We have found that a systematic, structured approach consisting of a detailed history and a thorough physical examination supplemented by the proper use of a variety of imaging modalities will establish accurately the diagnosis in almost all patients. Using such an algorithmic approach can greatly minimize medical costs and time lost from work as well as assist the surgeon in diagnosing the cause of wrist pain as quickly as possible. Even when this type of systematic approach is used in the evaluation of patients presenting with wrist pain, it is important for surgeons to remember that several imaging modalities, such as bone scans and arthrography, frequently demonstrate abnormal or atypical findings for which no pathologic correlate exists. If a firm diagnosis cannot be made even after a positive test result, it is unwise to perform surgery based solely on the findings of a test in the hope that wrist pain will thereby be relieved. In such cases, a trial of immobilization for 3 weeks is perhaps the best and most cost-effective way to verify that the pain is caused by an actual bone or joint abnormality that will respond to surgery.