It's not uncommon that I see a patient who complains of pain along the back side of the wrist, which is worse (and usually only present) when the wrist is fully extended (or bent backwards). These individuals feel a pinching discomfort in the wrist while doing activities such as yoga, pushups, or simply lifting themselves from a chair.
There are several conditions that can cause this pain, such as a small (occult) ganglion cyst, tendinitis, ligament injuries, or something called dorsal wrist impingement syndrome. In dorsal wrist impingement syndrome, the capsule (joint lining) becomes thickened and gets pinched in the back of the joint when the wrist is extended. Specifically, the capsule is pinched between the extensor carpi radialis brevis tendon and the scaphoid bone.
When examined, these patients will have pain when the back of the wrist is palpated, and pain when the wrist is maximally extended. X-rays are usually obtained to rule out other injuries to ligaments or bones within the wrist. Some patients will improve with rest, activity modification, splints, or anti-inflammatories.
In recalcitrant cases, an MRI is useful to gain more information. However, while an MRI may show a ganglion, tendinitis or ligament tear, patients with dorsal wrist impingement syndrome typically have a normal MRI. This is because the condition is “dynamic”, and the tissue is only pinched during activities, such as the “push-up” position.
If other treatment options fail, patients may benefit from wrist arthroscopy and removal of the redundant capsular tissue. In the March 2017 issue of the Journal of Hand Surgery, researchers showed that wrist arthroscopy can successfully remove this thickened capsule tissue, and was both a safe and effective procedure for improving pain and function.
Click here to view the full article in the Journal of Hand Surgery.
Having pain on the back of your wrist while extending the hand back? Book an appointment with Dr. Schreiber to discuss further.