The sore wrist without a fracture.

The possible causes of wrist pain in a patient with normal roentgenograms are many, and the above discussion of differential diagnosis is by no means intended to be all inclusive. Rather, my intent has been to provide a checklist of some of the more likely causes as well as a systematic approach to the identification of the cause. Many of the tests described are somewhat costly (Table 31-3), and they should not be ordered indiscriminately. Rather, the need for each test is determined by a reasonable presumptive diagnosis, depending on the history, clinical examination, and routine roentgenograms (see Table 31-1). Finally, I must say that even an exhaustive work-up may not be fruitful, and occasionally the precise cause for the patient's pain is never clearly identified. Our knowledge of the wrist is incomplete, and our diagnostic tools are not infallible, but we must continue to try to sort out these difficult wrist problems. The ultimate solutions to many of these enigmas will be dependent on our ability to correlate specific signs and symptoms with appropriate diagnostic modalities and observations at the time of operation.