Author: Matthew Negaard, BA
Co Author #1: Christopher Hogrefe, MD
Departments of Medicine, Emergency Medicine, and Orthopaedic Surgery, Northwestern Medicine; Chicago, Illinois
Editor: Tricia Beatty-Webner, DO
A competitive weightlifter presents with on month of dorsolateral left wrist pain aggrevated by wrist extension.
A 25-year-old, right handed male with no past medical history presents to Sports Medicine Clinic with one month of dorsolateral left wrist pain. The patient is a competitive weight lifter. He denies precipitating events or previous wrist pain. The patient reports sharp pain that has progressed over the past month, now rated at an 8 out of 10. Wrist extension during weight lifting significantly increases his pain. He notes decreased grip strength and marked pain with continued weight lifting. He is not taking any pain medication. He denies any erythema, ecchymosis, swelling, numbness, tingling, weakness, clicking, locking, popping, or instability of the left wrist. The patient denied fever, chills, or other joint pains.
Visualization of the left wrist is without erythema, ecchymosis, swelling, and/or atrophy. He is point tender directly over the volar aspect of the radial carpal joint, particularly the radial scaphoid joint (over the proximal portion of the scaphoid). He has full range of motion of the left wrist, though deep flexion elicits pain. He endorses mild pain with radial deviation and no pain with ulnar deviation; no laxity is appreciated with these movements. Radial pulses are 2+. Sensation is intact. Strength is 5/5 and symmetric throughout the wrists and hands. Watson's sign is slightly positive. Shuck testing is negative.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.