Hand and Wrist Pain Mind Map.jpg

This clinical mind map is organized based upon the site or location of the pain. Although the list of differentials for hand pain is relatively small, going through the diagnostic process may become a challenge if

1) The patient does not clearly state where the pain is located

2) Hand pain is a secondary manifestation of a systemic inflammatory process,

a) Which may not yet be causing symptoms outside of the hands 

b) Additional symptoms are present, but the patient may not bring those symptoms up, at least in the beginning, or

c) The patient does mention additional symptoms, but the clinician already anchored at a wrong diagnosis, and failed to identify a symptom that might have led to a correct diagnosis if the clinician had paid attention.

For the reasons described above, the clinician should make sure to

a) Obtain information about the precise location of pain, and

b) Ask about symptoms of systemic inflammatory processes to address those conditions.

There are almost no urgent/emergent situations associated with hand pain, except for cases of trauma or severe infection which can cause serious morbidity. These exceptions are usually easy to diagnose within the context of the situation. A physical exam that provides helpful information and imaging may be necessary to confirm the diagnosis.

To reduce cognitive load, ROC To TUD is an easy mnemonic to remember where each capital letter represents a diagnosis, with ROC being the most common diagnoses

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