Radial-sided wrist pain differentials: presentation, pathoanatomy, diagnosis, and management / Dolor radial de muñeca: diferencias en la presentación, anatomía patológica, diagnóstico y tratamiento

Abstract Patients with radial-sided wrist pain can be challenging to diagnose and treat. Various physicians, including emergency physicians, primary care physicians, and orthopedic or plastic surgeons can be involved in the initial and subsequent evaluation. We delve into the differential diagnosis of radial-sided wrist pain including osteoarticular, ligament, tendon, nerve, and other pathologies. We review the physical exam findings, diagnostic studies, and treatment options for each pathology based on recent and updated literature.

Resumen Los casos de pacientes que presentan dolor radial de muñeca pueden ser de difícil diagnóstico y tratamiento. Varias especialidades médicas, incluidas emergentólogos, médicos de atención primaria, cirujanos ortopédicos o cirujanos plásticos, pueden estar involucrados desde el inicio de la patología y subsecuente evaluación. Pro fundizamos aquí en el diagnóstico diferencial del dolor radial de muñeca incluyendo las debidas a patologías osteoarticulares, ligamentosas, tendinopatías y neuropatías, entre otras. Esta revisión incluye examen físico, estudios diagnósticos, y opciones terapéuticas para cada condición con base en la literatura reciente y actualizada.

Radial-sided wrist pain differentials: presentation, pathoanatomy, diagnosis, and management.

Patients with radial-sided wrist pain can be challenging to diagnose and treat. Various physicians, including emergency physicians, primary care physicians, and orthopedic or plastic surgeons can be involved in the initial and subsequent evaluation. We delve into the differential diagnosis of radial-sided wrist pain including osteoarticular, ligament, tendon, nerve, and other pathologies. We review the physical exam findings, diagnostic studies, and treatment options for each pathology based on recent and updated literature.

Los casos de pacientes que presentan dolor radial de muñeca pueden ser de difícil diagnóstico y tratamiento. Varias especialidades médicas, incluidas emergentólogos, médicos de atención primaria, cirujanos ortopédicos o cirujanos plásticos, pueden estar involucrados desde el inicio de la patología y subsecuente evaluación. Profundizamos aquí en el diagnóstico diferencial del dolor radial de muñeca incluyendo las debidas a patologías osteoarticulares, ligamentosas, tendinopatías y neuropatías, entre otras. Esta revisión incluye examen físico, estudios diagnósticos, y opciones terapéuticas para cada condición con base en la literatura reciente y actualizada.

Evaluating the Utility of Follow-up Radiographs for Isolated Radial Head Fractures Undergoing Initial Nonoperative Treatment.

OBJECTIVES: To evaluate the utility of follow-up radiographs in patients with isolated partial articular radial head fractures (OTA/AO 2R1B1 or 2R1B3). DESIGN: Retrospective cohort study. SETTING: Academic Level 1 Trauma Center. PATIENTS: Adult patients (≥18 years) with isolated partial articular radial head fractures indicated for initial nonoperative treatment. INTERVENTION: Analysis of elbow radiographs at initial presentation and at postinjury follow-up of 3-8 weeks. VARIABLES MEASURED: Articular gap and step-off. MAIN OUTCOME MEASURE: Radiographic articular displacement between initial and follow-up radiographs. RESULTS: For 72 included patients, initial radiographs were obtained on average 2.6 days after injury and follow-up radiographs 33.7 days thereafter. Equivalence tests evaluating gap and step-off thresholds of <1 mm were both significant, indicating that the cohort displaced <1 mm for both parameters between initial and follow-up radiographs. No patients proceeded to surgical treatment following the repeat radiographs. CONCLUSIONS: These fractures do not displace in the early postinjury period, as defined as a <1 mm of change in both intra-articular gap and step-off, as compared to initial radiographs. Routine follow-up radiographs for these injuries is a source of cost, but with limited utility in detecting interval displacement or leading to a change in management. Selective use of radiographs to evaluate specific clinical concerns may lead to cost savings. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Impact of Insurance Status on the Development of Nonunion following Scaphoid Fracture.

Purpose Certain factors have been associated with the development of scaphoid nonunion, including delayed diagnosis, smoking, inadequate initial management, proximal location, and carpal instability. We hypothesized that insurance status would also be a risk factor for the development of scaphoid nonunion. Methods A case-control study was performed on patients who presented to a single surgeon at a tertiary referral center during 2006 to 2015. Cases were patients presenting with nonunions, controls, and patients with acute fractures. Patients were characterized as underinsured if they lacked any type of insurance or if they were on Medicaid. Results Patients (39 nonunions [cases] and 32 primary fractures [controls]) presenting with nonunions were more likely than controls to have had displaced fractures (72 vs. 41%) and fractures located at the proximal aspect of the scaphoid (18 vs. 0%), and to be underinsured (46 vs. 19%). Conclusion Patients presenting with nonunions were more likely to be underinsured than patients presenting with primary fractures. This finding suggests that underinsurance is a risk factor for the development of nonunion. Assuming delay between fracture and intervention is a known risk factor for the development of nonunion, and it is likely that the association between nonunion and underinsurance is mediated through this delay. Level of Evidence Prognostic, level III, case-control study.