Dorsal Wrist Impingement

Dorsal wrist impingement (dorsal capsulitis) is a condition associated with pain and inflammation that affects the wrist’s dorsal (back) side. It arises when the dorsal wrist capsule, which is the soft tissue surrounding the wrist’s bones and ligaments, thickens and gets inflamed. Pinching or impingement in the affected area results from this.

Symptoms

Dorsal wrist impingement is characterized by the following symptoms:

• Pain: A sharp or throbbing pain on the back of the wrist during activities that require wrist extension like performing push-ups or yoga.
• Swelling: You can experience mild to moderate swelling at the wrist’s back.
• Tenderness: Heightened sensitivity to touch in the central dorsal wrist area.
• Stiffness: Limited wrist mobility, which makes full extension or flexion difficult.
• Loss of strength: Weakened grip that makes it challenging to hold objects.

Symptoms often develop gradually and may vary in intensity based on activity levels. Movements involving wrist extension usually exacerbate pain and discomfort.

Risk Factors

Dorsal wrist impingement primarily affects adults aged between 30 and 50, especially those who engage in activities that place repeated strain on the wrist. Common risk factors include:

• Yoga: Poses like downward dog and plank can lead to wrist impingement because of sustained wrist extension.
• Push-ups: Repeated wrist extension when doing push-ups can stress the dorsal wrist capsule, causing soft tissue inflammation and pain.
• Gardening: Tasks such as weeding, digging and handling gardening tools can overwork the extensor tendons in the wrist.
• Racket sports: Sports like tennis and racquetball involve repeated wrist motions that may cause dorsal wrist capsule irritation.
• Manual labor: Jobs requiring frequent wrist extension, including carpentry, typing, and assembly line work, can raise the likelihood of developing this condition.

Dorsal Wrist Impingement Diagnosis

At The Joint Pain Clinic, diagnosing dorsal wrist impingement mostly involves a combination of a physical exam, a review of medical history as well as imaging tests.

Physical examination

The physician will assess the wrist for tenderness, pain, and swelling in the central dorsal area. They will also check for restrictions in wrist movement, particularly when twisting and straightening. Certain tests may be conducted to evaluate pain with wrist extension and the state of the tendons and ligaments.

Medical history review

The clinician will discuss your symptoms, daily activities, and any past wrist injuries. Special attention will be given to incidents such as a fall onto an outstretched hand (FOOSH).

Imaging tests

Diagnostic ultrasound may be used to detect thickening of the joint lining (synovium) and capsule in the wrist’s back. Additionally, imaging can help identify wrist ganglions—small, fluid-filled cysts commonly found in this area.

Treatment

Dorsal wrist impingement treatment aims to reduce inflammation, relieve pain and restore wrist mobility. Non-surgical approaches are normally effective and can involve the following:

• Rest: Refrain from activities that exacerbate pain, especially those that involve weight-bearing on an extended wrist, such as push-ups and certain yoga poses.
• Splinting: Use a wrist splint or brace to immobilize the joint, reduce strain on the inflamed capsule, and promote healing.
• Ice therapy: Apply ice packs for at least 10 to 15 minutes several times a day in order to help ease pain and inflammation.
• Pain relief medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be helpful in managing mild to moderate pain and swelling.
• Physiotherapy: To improve wrist flexibility, strengthen surrounding muscles and encourage proper movement patterns, a physical therapist may recommend exercises and stretches.
• Ergonomic adjustments: The use of ergonomic gears like wrist supports for keyboards and mouse pads can minimize strain when working or using a computer.
• Corticosteroid injections: Sometimes, a steroid injection into the dorsal wrist capsule may temporarily relieve inflammation and pain.

Surgical intervention may be considered if these non-surgical treatments do not provide sufficient relief.