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Differential diagnosis and physical therapy management of a patient with radial wrist pain of 6 months' duration: a case.

Abstract

STUDY DESIGN
Case report.
BACKGROUND
Differential diagnosis for patients with radial wrist pain requires consideration of systemic disease, referred pain to the radial aspect of the wrist, and local dysfunction. The list of possible local dysfunctions should include De Quervain syndrome, as well as entrapment neuropathy of the superficial radial nerve.
CASE DESCRIPTION
The patient was a 57-year-old man with right radial wrist pain of 6 months' duration. The referral diagnosis was De Quervain syndrome, but a previous course of electrophysical agents-based physical therapy management had been unsuccessful. The physical examination ruled out the cervical, shoulder, elbow, and wrist joints as possible sources of pain. In this case, the diagnosis of entrapment neuropathy of the superficial radial nerve, rather than De Quervain syndrome, was primarily based on the symptom provocation resulting from a modified radial bias upper limb nerve tension test. Based on this diagnosis, treatment consisted of active and passive exercises using neurodynamic techniques.
OUTCOMES
After 1 treatment session, the patient noted changes with regard to current pain intensity and function that exceeded the minimal clinically important difference and the minimal detectable change, respectively. After only 2 treatment sessions, the patient reported a complete resolution of symptoms and a full return to work.
DISCUSSION
This case report critically evaluates the diagnostic process for patients with radial wrist pain and suggests neuropathy of the superficial sensory branch of the radial nerve as a differential diagnostic option.
LEVEL OF EVIDENCE
Therapy, level 4.J Orthop Sports Phys Ther 2010;40(6):361-368, Epub 22 April 2010. doi:10.2519/jospt.2010.3210.

Links

  • Publisher Full Text

    • Authors

    González-Iglesias J, Huijbregts P, Fernández-de-Las-Peñas C, Cleland JA

    Institution

    Centro de Fisioterapia Integral, Candas, Asturias, Spain.

    Source

    The Journal of orthopaedic and sports physical therapy 40:6 2010 Jun pg 361-8

    MeSH

    Arthralgia
    De Quervain Disease
    Diagnosis, Differential
    Humans
    Male
    Middle Aged
    Nerve Compression Syndromes
    Pain Measurement
    Physical Examination
    Physical Therapy Modalities
    Radial Neuropathy
    Wrist Joint

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    20511694