What is the focus of clinical history in the evaluation of ulnar-sided wrist pain?

Updated: Nov 22, 2019
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

Answer

A thorough history often suggests or reveals the diagnosis of wrist pain. A careful history includes the timing of the injury—whether the wrist pain was caused by an acute injury or brought on by repetitive motions of the wrist. Information should be gathered regarding the location, duration, and radiation of pain. Any associated swelling, burning, or tingling should be documented.

Questioning the patient regarding specific sounds or sensations about the wrist is beneficial. Patients often describe grinding, snaps, clicks, or clunks, each of which is unique in sound quality and pathology. A click usually represents a medium-pitched sound that is caused by two bones rubbing together, as in triquetral instability. A snap is often high pitched and is associated with a subluxing tendon. Clunks are low-pitched sounds and may be the only presenting symptom of joint subluxation such as midcarpal instability. Grinding or crepitus is high pitched, usually representing synovitis. Eliciting this information may help the examiner narrow the differential diagnosis considerably (see Differential Diagnosis).


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