Dorsal Wrist Impingement – How to Diagnose

Dorsal wrist impingement is pincing of dorsal wrist capsule between the extensor carpi radialis brevis and the dorsal ridge of the scaphoid. It’s diagnosis is strictly clinical.

J Hand Surg [Am]. 2008 Sep;33(7):1201-4. Arthroscopic management of dorsal wrist impingement. Henry M. abstract

  • Often minor initialing event
  • loaded extesnion hurts – pushing up from chair or pushing heavy door open.
  • sometimes associated dorsal wrist ganglion
  • secondary issues could be scapholunate instability or scaphoid rotatory subluxation – scaphoid shifts at times and pinches
  • Schaphoid shift test(aka Watson test(from http://www.fpnotebook.com/Ortho/Exam/ScphdShftTst.htm

Thumb on tubercle, index dorsally . Push back and forth and as wrist moved radial- ulnar deviation.

If hurts on tubercle is a problem, if clunks – is unstable

Rx – inject steroid which can be repeated 1-2 times

Sometimes capsulectomy done.

Any expereince with this?

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One Response to Dorsal Wrist Impingement – How to Diagnose

  1. nancy medina says:

    My wrist has been hurting for a quite a while now and I went to physical therapy once before but they could not define what it could have been. My wrist does not hurt everyday, but when it does it hurts all day and I have to be very carefull with the things I pick up. A cellphone start to bother me when I am texting. I am right handed but this only occurs with my left which I bearly even use. Any advice would help.
    ————–
    This sounds like some form of instability of one of your wrist joints. This can be difficult to decide where it is exactly.

    On the thumb side, Scapholunate instability is the most common:
    BEWARE THE SPRAINED WRIST: THE INCIDENCE AND DIAGNOSIS OF SCAPHOLUNATE INSTABILITY
    W. A. JONES
    J Bone Joint Surg Br March 1988 vol. 70-B no. 2 293-297
    http://www.bjj.boneandjoint.org.uk/content/70-B/2/293.full.pdf+html

    Put your opposite thumb in the snuff box of the affected wrist:
    http://t3.gstatic.com/images?q=tbn:ANd9GcSK7C6PG06RVDTvdXyJSK4rLHMaIEbsOXQtJFX10meLYaO6-z2Nxue4AMpJww
    Circle your remaining fingers around affected side thumb and pull.
    While pulling, press thumb in snuff box and see if that helps.

    On the small finger side, the Triangular fibrocartilage could be the source of pain:
    http://en.wikipedia.org/wiki/Triangular_fibrocartilage

    Put your opposite side thumb on the pisiform of wrist as in pic but not with wrist bent over to that side:
    http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/dumontier_synth/figures/fig16.JPEG
    Put your opposite side index finger just below your wrist joint.
    Squeezing with your two fingers should mobilize that joint and you can see if that is where the pain is coming from and whether that helps to mobilize it.

    Lots more areas that could be affected and you need to see either a physio or specialist good at wrists. Unfortuantely, you need to be seen when it hurts….

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