Left Wrist Pain: 7 Common Causes (Tendinitis, Carpal Tunnel, Arthritis) and Next Steps After Negative X-Ray
With negative X-ray (no fracture/dislocation), consider:
- Tendinitis/Tendinopathy: De Quervain's (1st dorsal compartment), ECU, FCR/FCU. Pain with specific tendon loading.
- Carpal tunnel syndrome: Median nerve compression at wrist. Nocturnal paresthesias (thumb/index/middle), thenar wasting late.
- Arthritis: OA (trapeziometacarpal, STT), RA (synovitis, ulnar drift), CPPD (pseudogout).
- Ligament injury: Scapholunate (SL) tear → dorsal wrist pain, clunk; TFCC tear → ulnar-sided pain.
- Nerve compression: Ulnar nerve (Guyon's canal), radial nerve (Wartenberg's).
- Infection: Septic arthritis, tenosynovitis (rare without portal).
- Occult fracture: Scaphoid (snuffbox tenderness), pisiform, hamate hook. MRI/CT if high suspicion.
Next: Targeted exam, nerve conduction studies, ultrasound, or MRI. Referral to hand surgeon if mechanical symptoms or progressive deficit.
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