Arthroscopic Surgery for Dorsal Wrist Impingement

Dorsal wrist impingement is an injury where the back of the radius (one of the forearm bones) hits against the wrist bones and traps the nerves. It's a common injury, particularly in sports like gymnastics, where the gymnasts place a lot of force on their wrists with hand springs and walk overs. However, it can also occur from a minor injury.

When a patient has a dorsal wrist impingement, there is usually pain on the top of the wrist, especially when the hand is bent back towards the shoulder, as when pushing a door open. Usually, the first treatment for the problem is injections of a corticosteroid to the painful area and rest. Unfortunately, not all cases respond to this and then surgery may be necessary.

There is no specific test to diagnose dorsal wrist impingement. It's not seen on x-ray or imaging, for example. So doctors have to rely on the patient's history of the injury and by ruling out other problems that may be causing the wrist pain. Dorsal wrist impingement has specific location of pain and this pain can be brought on by certain wrist movements. Also, if it truly is dorsal wrist impingement, corticosteroid injections should have helped relieve the pain somewhat - perhaps relieving up to 70 percent of the pain, for several weeks. So, in order to decide on surgery, the patient should have been treated with at least one or two corticosteroid injections and have rested the wrist for at least three months.

Patients who should not have this surgery are those for whom dorsal wrist impingement can't be absolutely diagnosed, as well as those who are in poor health, if a patient isn't compliant with treatments, or has an infection.

Following surgery, the wrist isn't braced or casted. In fact, wrist movement is encouraged and the goal is to have full range of motion of the wrist within two to three weeks of surgery. Strength rehabilitation begins once range of motion is full and patients generally are able to return to office-type work within two weeks of surgery and to heavier work within six weeks.

There are some complications related to the procedure that should be taken into consideration and these complications are related to wrist surgery in general, not specific to surgery for dorsal wrist impingement. While performing the surgery, the nerves to the wrist are vulnerable to being damaged, for example. And, after surgery, if the patient isn't compliant and doesn't participate in exercises to regain range of motion, they may lose the ability to bend the wrist, although the risk isn't as high with arthroscopic surgery as it is with open surgery.

Reference: 

Mark Henry, MD. Arthroscopic Management of Dorsal Wrist Impingement. In Journal of Hand Surgery. September 2008. Vol. 33A. Pp. 1201-1204.

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