Fisherman has pain, decreased grip strength – Let’s diagnose

A 49-year-old man presented to the doctor with complaints of ulnar-sided wrist pain, joint stiffness, and decreased grip strength that had developed over 2 months. The patient was a fisherman working as an oyster shucker and reported wrist pain while at his job. The pain was relieved by rest. While he had not had recent trauma to the hand/wrist region, about a decade ago, he sustained a distal radius fracture due to a fall onto an outstretched hand, which healed with closed management and did not require surgery.

On physical examination, joint tenderness was present over the ulnar head and triquetrum during palpation. Radiographs revealed soft tissue swelling and a positive ulnar variance of 2.3 mm – the distal ulna was slightly longer than the distal radius.

What’s the diagnosis?

  1. Ulnocarpal abutment syndrome
  2. Extensor carpi ulnaris (ECU) tendonitis
  3. Basilar thumb arthritis
  4. Distal radioulnar joint (DRUJ) arthritis

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