In the hustle and bustle of office-based city life, wrist injuries often go unnoticed until they become debilitating. One such common injury is dorsal wrist impingement, which affects many professionals working in desk-based settings.

Here we highlight the anatomy, causes, symptoms, diagnosis, and management of dorsal wrist impingement to help city workers to prevent and manage this condition effectively.

Anatomy of the Wrist

The wrist is a complex joint comprised of multiple bones, ligaments, tendons, and muscles that allow for intricate movements necessary for daily activities. The dorsal aspect of the wrist, located on the back of the hand, is particularly susceptible to impingement injuries due to its complex anatomy.

The wrist joint is composed of eight carpal bones, including the scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, and trapezium, which articulate with the distal ends of the radius and ulna bones of the forearm.

Causes of Dorsal Wrist Impingement

Dorsal wrist impingement occurs when there is compression or irritation of the structures on the dorsal aspect (back) of the wrist joint. This can result from repetitive motions, overuse injuries, trauma, or degenerative changes in the wrist joint.

Office-based city workers are particularly prone to dorsal wrist impingement due to prolonged hours of typing on keyboards, using computer mice, and performing repetitive wrist movements associated with office tasks.

Mechanism of Injury

The repetitive nature of office work, combined with poor ergonomics and prolonged periods of wrist extension, can lead to dorsal wrist impingement. When the wrist is repeatedly extended or hyperextended, the ligaments, tendons, and soft tissues on the dorsal aspect of the wrist can become pinched or compressed between the carpal bones and the distal end of the radius.

This constant pressure and friction can cause inflammation, pain, and structural damage, leading to dorsal wrist impingement syndrome.

Symptoms of Dorsal Wrist Impingement

Patients experiencing dorsal wrist impingement may present with a range of symptoms, including:

• Dorsal wrist pain exacerbated by wrist extension or repetitive movements.
• Swelling and tenderness on the back of the wrist.
• Decreased range of motion and stiffness in the wrist joint.
• Weakness and instability in the wrist during gripping activities.
• Clicking or popping sensations with wrist movement.
• Difficulty performing daily tasks that require wrist mobility, such as typing or lifting objects.

Diagnosis of Dorsal Wrist Impingement

Diagnosing dorsal wrist impingement involves a comprehensive evaluation of the patient’s medical history, symptoms, and physical examination findings.

Imaging studies, such as X-rays, magnetic resonance imaging (MRI), or ultrasound, may be ordered to assess the structural integrity of the wrist joint and identify any underlying abnormalities, such as bone spurs or ligamentous injuries.

Additionally, diagnostic wrist arthroscopy may be performed to assess the internal structures of the wrist joint, clean out the joint, and confirm the diagnosis of dorsal wrist impingement.

Nonsurgical Management of Dorsal Wrist Impingement

For office-based city workers with mild to moderate dorsal wrist impingement, nonsurgical management strategies may be effective in alleviating symptoms and improving wrist function.

These may include:

• Rest and activity modification: Limiting repetitive wrist movements and avoiding activities that exacerbate symptoms.
• Immobilisation: Wearing a wrist splint or brace to immobilise the wrist joint and reduce stress on the affected tissues.
• Physical therapy: Performing specific exercises to strengthen the muscles surrounding the wrist joint and improve range of motion.
• Anti-inflammatory medications: Taking nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation in the wrist.
• Corticosteroid injections: Administering corticosteroid injections into the affected area to alleviate pain and inflammation.

Surgical Management of Dorsal Wrist Impingement

In cases where conservative treatments fail to provide relief, surgical intervention may be necessary to address dorsal wrist impingement.

Surgical options may include:

• Arthroscopic debridement: Using minimally invasive arthroscopic techniques to remove damaged tissues, bone spurs, or inflamed synovium causing impingement.
• Ligament reconstruction: Repairing or reconstructing damaged ligaments in the wrist joint to restore stability and function.
• Osteotomy: Performing a surgical procedure to realign the bones of the wrist joint and alleviate pressure on the dorsal structures.
• Joint fusion: Fusing the affected carpal bones together to stabilise the wrist joint and prevent impingement.

Conclusion

Dorsal wrist impingement is a common condition that can significantly impact the quality of life for office-based city workers.

With proper ergonomics, lifestyle modifications, and prompt medical intervention, individuals can alleviate pain and restore function.

If you are suffering with wrist pain, then please book an appointment with one of our expert hand and wrist specialists for a full assessment and diagnosis.

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