Dorsal Wrist Impingement Syndrome
Dorsal wrist impingement syndrome is a wrist condition that causes pain along the back (dorsal) side of the wrist. A pinching discomfort, or pain, is felt when the wrist is bent backwards (extended). This may be brought on by downward dog, plank or other poses during yoga, when doing pushups, or simply when pushing yourself up from a chair.
Causes
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 most often pinched between the extensor carpi radialis brevis tendon and the scaphoid bone.
Diagnosis
Talking with a hand physician about your symptoms and explaining when and where you have discomfort, along with allowing them to examine your wrist, is typically sufficient to make the diagnosis. Pain can usually be reproduced by maximally extending the wrist or by applying pressure against (palpating) the back of the wrist.
X-rays are oftentimes obtained to rule out other injuries. X-rays may show a fractured or broken bone, or may show abnormal spaces between the bones of the wrist, suggesting a torn ligament.
In recalcitrant cases, an MRI may be ordered. This helps to look for other causes of pain along the back of the wrist, such as a ganglion cyst, tendinitis, or injured ligament. In dorsal wrist impingement syndrome, the MRI may be read by the radiologist as “normal”. This is because the condition is oftentimes “dynamic”, meaning the tissue is only pinched when the wrist is in certain positions.
Treatment
Non-operative treatment
Activity modification and rest – avoid activities producing pain, things may calm down if not repeatedly aggravated
Wrist brace – this will limit wrist motion, which can allow the inflamed joint lining to shrink back to a normal size
Oral NSAIDs (Aleve/ibuprofen, or Advil/naproxen) – can help with discomfort, and decrease inflammation within the irritated tissues
Cortisone injection – when injected into the back of the wrist, can be effective at calming and shrinking the inflamed joint capsule
Surgery
When symptoms persist despite a period of attempting conservative interventions, and when pain is limiting activities, surgery may be considered. Surgery for dorsal wrist impingement syndrome is usually performed arthroscopically. This is a small outpatient procedure, where a camera is inserted into the wrist joint through a small hole along the back of the wrist. This allows for excellent visualization of all of the structures within the joint. In this condition, the joint lining, or capsule, can become thickening and inflamed. The abnormal tissue, “synovitis”, is removed with a second instrument called a “shaver” placed through another small hole in the back of the wrist. While watching on a screen, the abnormal tissue that is being pinched between structures is removed, or trimmed back, by the shaver.
Dorsal Wrist Impingement Syndrome: Images above are photos taken during arthroscopic wrist surgery. 1. On the left, abnormally thickened joint lining is caught between the radius and lunate bones, where it can be pinched and produce pain. 2. The middle image shows a probe along the abnormal tissue. 3. On the right, an arthroscopic shaver is shown. This acts like a vacuum, and has oscillating teeth that trims back the abnormal tissue.
After surgery, a splint is usually worn for ~2 weeks, then activities are resumed as tolerated.
Read more about dorsal wrist impingement syndrome here
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.