The patient should describe thoroughly any recent trauma, as its mechanism of injury may give up the diagnosis. For instance, a fall onto an outstretched hand during practice of contact sports is a common mechanism for fractures of the distal radius or scaphoid, whereas a direct palmar trauma from swinging a baseball bat or golf club could lead to a fracture of the hook of the hamate. Ligament tears may also occur, mainly at the TFCC, scapholunate and/or lunotriquetral ligaments. Depending on the kinetic energy of the trauma, these ligament injuries could either be partial or complete, isolated or associated with either distal radius fractures or scaphoid fractures. TFCC tears (with or without DRUJ instability) are often seen in gymnastic and racquet sports and may mimic extensor carpi ulnaris (ECU) pathology.

At times, trauma kinetics of a given wrist lesion remains elusive. In these situations, symptom duration may provide a temporal clue related to a vague history of trauma, while the patient refers spontaneous onset of the pain. Sometimes, the examiner faces such challenging scenario in patients with carpal bone nonunion or avascular necrosis, in whom symptoms may manifest several years after the index injury because of ongoing inflammation, leading to arthritis, swelling, pain, and loss of grip strength. The scaphoid is particularly prone to developing nonunions [5]. The latter is due to its vulnerable blood supply that can lead to complete vascular interruption of a bone fragment following wrist trauma. Idiopathic avascular necrosis generally occurs either at the lunate (Kienböck’s disease) or at the scaphoid (Preiser’s disease).

Several leisure or labor activities can affect wrist function. For example, long-standing history of typing that involves repetitive motion can trigger wrist pain, while knitting or sewing may lead to compressive neuropathy. Activities requiring forceful grasping with ulnar deviation or repetitive use of the thumb (e.g., caring for a newborn infant) can lead to De Quervain’s tenosynovitis with pain and swelling along the first extensor compartment.

Specific details regarding sport activities can be very informative about the mechanism of injury: repetitive stress versus blunt trauma. Contact sports, such as American football or rugby, may lead to blunt trauma, while noncontact sports, such as golf, tennis, field hockey involve repetitive stress of the wrist.

The presence of a painful clunking on the ulnar side of the wrist during activities that involve active ulnar deviation indicates midcarpal instability. In patients with symptoms at the ulnar side of the wrist, the examiner should to rule out DRUJ arthritis, ulnocarpal or stylocarpal impaction syndrome.

While obtaining a thorough complete medical history, the physician should exclude the presence of systemic inflammatory disorders (lupus, rheumatoid arthritis, and degenerative arthritis), metabolic diseases (diabetes, gout, and hypothyroidism) in addition to previous surgeries. Pregnancy, hypothyroidism, and diabetes are predisposing risk factors for carpal tunnel syndrome. Rheumatoid arthritis has a tendency to involve the wrist while gouty arthritis and pseudo gout can involve the wrist joint, although more commonly they affect the lower extremities.

Patients with septic arthritis typically present with a history of constitutional symptoms or a recent infection and a poorly moveable wrist owing to severe, deep, and unrelenting pain.

Patient’s age and sex should also be considered. As example, younger patients are prone to posttraumatic carpal injuries and occult ganglion cysts, whereas older patients are susceptible to systemic diseases and degenerative processes.