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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.


METHODS
Therapy, level 4.J Orthop Sports Phys Ther 2010;40(6):361-368, Epub 22 April 2010. doi:10.2519/jospt.2010.3210.
Centro de Fisioterapia Integral, Candas, Asturias, Spain.
Javier
J
González-Iglesias
Peter
P
Huijbregts
César
C
Fernández-de-Las-Peñas
Joshua A
JA
Cleland
D018771:Arthralgia / Q000209:etiology / Q000628:therapy*; D053684:De Quervain Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000628:therapy*; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods; D026741:Physical Therapy Modalities; D020425:Radial Neuropathy / Q000175:diagnosis* / Q000628:therapy*; D014955:Wrist Joint