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Causes of wrist pain
Scenario 1: A male 27-year-old university rower who plays the drums complains of wrist pain.
Clinical Rationale:
Extensor carpi ulnaris (ECU) subluxation and tenosynovitis.
Scenario 2: A 43-year-old woman on anti-tumour necrosis factor (anti-TNF) medication reports
Clinical Rationale:
Vaughn–Jackson syndrome.
Scenario 3: A 23-year-old woman presents with radial-sided wrist pain. Her full-time job is
Clinical Rationale:
De Quervain’s disease. This question is really a test of the seven extensor compartments. Each compartment has its own unique anatomy and pathology in turn. Rowers and drummers have ECU subluxation and tenosynovitis. It is common for young mothers to develop tenosynovitis of the first extensor compartment but the condition is not exclusive to them. Vaughn-Jackson syndrome is the attritional rupture of the extensor digiti minimi (EDM) in rheumatoid arthritis. The compartments are as follows: First – abductor pollicis longus and extensor pollicis brevis tendons Second – extensor carpi radialis longus and extensor carpi radialis brevis tendons Third – extensor pollicis longus tendon Fourth – three tendons of extensor digitorum muscle and the extensor indicis tendon Fifth – extensor digiti minimi tendon Sixth – extensor carpi ulnaris
Infections in the hand
Scenario 1: A 26-year-old presents to the emergency department with a small laceration
Clinical Rationale:
Eikenella corrodens.
Scenario 2: A dentist presents with recurrent vesicles on the fingers and pain.
Clinical Rationale:
Herpes simplex virus type 1.
Scenario 3: A 65-year-old woman was bitten by a cat on the dorsum of the left wrist and
Clinical Rationale:
Pasteurella multocida. The most common cause of hand infections is probably still Staphylococcus aureus. However, because the hands come into contact with specific things it is important to recognize a few important infections. A ‘fight bite’ often presents with a small wound and a history of punching. Eikenella corrodens comes from the human mouth. Dentists and healthcare workers are exposed to the herpes virus. The typical organism in cat bites is Pasteurella. The organisms in necrotizing fasciitis are multiple and usually include clostridia and Group A b-streptococci.
