Now and then
Chronic wrist pain: diagnosis and management. Development and use
of a new algorithm
Richard M van Vugt, Johannes W J Bijlsma, Arno C van Vugt
Department of
Rheumatology and Clinical Immunology, F02.127, University Medical
Centre Utrecht, POBox 85500, 3508 GA Utrecht, the Netherlands
Correspondence to: Dr R M van Vugt.
Accepted for publication 19 June 1999
OBJECTIVE
Chronic
wrist pain can be difficult to manage and the differential diagnosis is
extensive. To provide guidelines for assessment of the painful wrist an
algorithm was developed to encourage a structured approach to the
diagnosis and management of these patients.
METHODSA review of
the literature on causes of chronic wrist pain was undertaken; history
taking, physical examination and imaging studies were evaluated
systematically to determine which of the many potential conditions was
the cause of the wrist pain. Chronic wrist pain was subdivided into
pain of probable intra-articular or extra-articular origin. By means of
this classification a clinical algorithm was developed to establish a
diagnosis and its clinical usefulness was tested in a prospective study
of 84 patients presenting to our outpatient clinic.
RESULTSA definite
diagnosis could be established in 59% (49 of 84) of the cases by
careful history taking, extensive physical examination, plain
radiographs, ultrasound examination and bone scintigraphy. In 19% of
the cases (16 of 84) a probable diagnosis was made resulting in a total
figure 78% (65 of 84). Additional imaging studies (arthrography, magnetic resonance imaging and computed tomography) increased the
definite diagnoses to 70% (59 of 84).
CONCLUSIONThe
algorithm proved easy to use and by the use of careful history taking,
thorough physical examination and simple imaging techniques
(ultrasonography and scintigraphy) a diagnosis was made in 78% of cases.
© 1999 by Annals of the Rheumatic Diseases
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This article has been cited by other articles:
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Al-Janabi, M.
(2002). Imaging modalities of the painful wrist: the role of bone scintigraphy. Rheumatology (Oxford)
41: 1085-1087
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