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Dorsal Wrist Impingement

What is dorsal wrist impingement?

Dorsal wrist impingement, also known as dorsal capsulitis is a condition that causes pain and inflammation in the back (dorsal) side of the wrist. It occurs when the dorsal wrist capsule, the soft tissue that surrounds the bones and ligaments in the wrist, becomes thickened and inflamed, leading to pinching or impingement in the back of the wrist.

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Who is affected by dorsal wrist impingement?

 

Dorsal wrist impingement is most common in adults between the ages of 30 and 50, particularly those who participate in activities that put repetitive stress on the wrist, such as:

  • Yoga

    Downward-dog, plank, and other poses can contribute to dorsal wrist impingement.

  • Push-ups

    Repetitive wrist extension during push-ups can strain the dorsal wrist capsule leading to inflammation of the soft-tissues and pain.

  • Gardening

    Activities like digging, weeding, and using gardening tools can overuse the wrist extensor tendons.

  • Racket sports

    Tennis, racquetball, and other racquet sports involve repetitive wrist movements that can irritate the dorsal wrist capsule.

  • Manual labour

    Jobs that require repetitive wrist extension, such as typing, carpentry, and assembly line work, can increase the risk of dorsal wrist impingement.

What are the main symptoms of dorsal wrist impingement?

 

The main symptoms of dorsal wrist impingement include:

  • Pain:

    Aching or sharp pain on the back of the central wrist, often worse with activities that involve wrist extension, such as pushing up from a chair, doing push-ups, or performing yoga poses.
  • Swelling:

    Mild to moderate swelling on the back of the wrist.
  • Tenderness:

    Increased sensitivity to touch on the back of the central wrist.
  • Stiffness:

    Reduced range of motion in the wrist, making it difficult to fully extend or flex the wrist.
  • Loss of strength:

    Weakened grip strength and difficulty holding objects.

Symptoms may worsen gradually over time and may fluctuate depending on the level of activity. Activities that involve wrist extension, such as pushing up from a chair or doing push-ups, tend to aggravate the pain and discomfort.

How is dorsal wrist impingement diagnosed?

 

Diagnosis of dorsal wrist impingement typically involves a physical examination, medical history review, and sometimes imaging tests.

Physical examination

The doctor will carefully examine the wrist, checking for pain, tenderness and swelling in the central dorsal wrist, with limitation of the range of motion when bending and straightening. Specific tests may be performed to assess pain with wrist extension and to evaluate the integrity of the wrist tendons and ligaments.

Medical history

The doctor will inquire about the patient's symptoms, activities and any previous wrist injuries, especially a Fall Onto the Out-Stretched Hand (FOOSH).

Imaging tests

ultrasound will allow the clinician to look for thickening of the synovium (joint lining) and capsule in the back of the wrist, as well as a wrist ganglion (small, simple, fluid-filled cysts most frequently seen in this part of the wrist).

How is dorsal wrist impingement treated?

 

Treatment for dorsal wrist impingement focuses on reducing inflammation, alleviating pain, and restoring range of motion in the wrist. Non-surgical treatments are usually effective and may include:

  • Rest:

    Avoiding activities that aggravate the pain, in particular press-ups and certain yoga positions where the body weight is placed through the wrist in an extended position.
  • Splinting:

    Wearing a splint or brace can immobilize the wrist and reduce pressure on the inflamed capsule, allowing for rest and healing.
  • Ice application:

    Applying ice packs to the affected area for 10-15 minutes at a time, several times a day, can help reduce inflammation and pain.
  • Over-the-counter pain relievers:

    Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate mild to moderate pain and inflammation.
  • Physiotherapy:

    Physiotherapy can provide exercises and stretches to improve range of motion, strengthen the muscles around the wrist, and promote proper wrist movement patterns.
  • Ergonomic modifications:

    Using ergonomic tools, such as keyboard wrist rests and mouse pads, can help reduce strain on the wrist and hand during work or computer use.
  • Corticosteroid injections:

    In some cases, corticosteroid injections into the dorsal wrist capsule can provide temporary pain relief and reduce inflammation.

At The Joint Injection Clinic, these injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a seated position with your hand resting on the couch.  The hand is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  The combined local anaesthetic and steroid is injected from the skin to the wrist joint under ultrasound guidance. 

The injection itself is normally completed within 30 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following this particular injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

If non-surgical treatments fail to provide adequate relief, surgery may be considered.