Atypical Wrist Pain - Page #1

Author: Nicholas Moore, MD
Co Author #1: Giselle Aerni, MD
Co Author #2: Tessa Balach, MD

Patient Presentation:
A 31 year old male with a two month history of insidious onset left volar wrist mass.

He describes a sensation of catching/clicking at the location of the mass with full finger flexion. This movement is also associated with some pain. He endorses localized pain to the site of the mass which is usually worse in the morning, improves throughout the day, and then worse again after work. His symptoms have remained unchanged over the course of two months. He denies swelling or numbness.

He has no prior history of wrist injury and no other significant past medical, surgical, social or family history. He does repetitively use his wrist working as a saw operator.

Physical Exam:
General: Pleasant, fit young male in no apparent distress.
Left Wrist:
Inspection: No overlying skin changes. No visible mass while the fingers are extended. However, when he moves into full finger flexion, a small mass appears just ulnar to the palmaris longs at the level of the wrist crease. The mass again disappears as he moves into extension. The mass is oval shaped, measuring roughly 1cm x 2 cm.
Palpation: The mass is firm, non-tender, mobile, non-fluctuant, and feels continuous with the underlying tendon. It is palpable just beneath the carpel tunnel as he moves his fingers into full flexion.
ROM: Full wrist flexion and extension, full finger flexion and extension.
Strength: 5/5 wrist flexion and extension, 5/5 finger flexion and extension.
Special Tests: Tinel, Phalen and Durkan's tests are negative.
Neurovascular: 2+ radial pulses, negative Allen's test, intact DTRs and light touch.

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