Overuse sport injuries to the wrist

Wrist overuse injuries are common in many sports, says Dr Arvind Mohan

Overuse injuries of the wrist are commonly reported in athletes. About half of all athletes sustain injuries of the wrist, of which 25–50 per cent are from overuse. These injuries are frequent in activities such as racquet sports, rowing, volleyball, handball and gymnastics.

De Quervain’s syndrome
De Quervain’s syndrome results from microtrauma-induced inflammation caused by repetitive gliding of the first dorsal compartment tendons abductor pollicis longus and extensor pollicis brevis, beneath the sheath of the first compartment over the radial styloid.

Activities requiring forceful grasping coupled with ulnar deviation or repetitive use of the thumb predispose the athlete to this condition.

The left thumb of a right-handed golfer is particularly at risk owing to the hyperabduction required during a golf swing.

The athlete presents with radial wrist pain and tenderness over the first dorsal compartment. Finkelstein’s test involves the patient flexing the thumb into the palm while the examiner ulnarly deviates the wrist, reproducing the patient’s symptoms.

Treatment involves rest, splinting, anti-inflammatory medications and possible steroid injection.

Additional injections may be indicated, and if no progress occurs, surgical release of the first dorsal compartment need to be performed.

Intersection syndrome
Intersection syndrome is inflammation of the peritendinous tissue located at the crossing points of the first dorsal compartment muscles and the radial wrist extensors 4–6cm proximal to the radial carpal joint. It is also known as ‘squeaker’s wrist’. Physical exam reveals tenderness and swelling at the intersection point, and crepitus is frequently noted as the wrist is actively extended and flexed.

Treatment involves rest, splinting, anti-inflammatory medications and possible steroid injection.

ECU tendinitis
Extensor carpi ulnaris (ECU) tendinitis involves inflammation of the tendon and occurs in rowing and racquet sports.

Treatment involves splinting, rest, anti-inflammatory medication, occasional steroid injection of the sheath and attention to technique modification to avoid recurrence.

Subluxation of the ECU
Subluxation of the ECU results from disruption or stretching of the ECU fibro-osseous tendon sheath usually due to a sudden volar flexion ulnar deviation stress such as hitting a low forehand in tennis.

Diagnosis may be made by having the athlete actively ulnarly deviate the wrist in full supination while observing the ECU tendon subluxing ulnarward over the styloid process.

Wrist flexor tenosynovitis
Flexor carpi radialis or flexor carpi ulnaris (FCU) tendinitis is rarely seen in athletics. FCU tendinitis is the more common and has been reported in golf and racquet sports such as badminton and squash.

Pisotriquetral arthritis may be an accompanying condition since the pisiform is a sesamoid bone within the substance of the FCU. Treatment involves rest and splinting of the wrist and corticosteroid injection into the sheath or pisotriquetral joint.

Carpal tunnel syndrome
Young athletes occasionally present with acute carpal tunnel syndrome due to significant tenosynovitis of the digital flexors secondary to repetitive digital flexion activities. Symptoms will resolve with splinting, anti-inflammatory medication and steroid injection.

Dorsal impingement
Dorsal impingement syndromes are common in sports with repetitive dorsiflexion of the wrist accompanied by axial loading. It may result from dorsal capsulitis or synovitis with resultant capsular thickening.

In prolonged cases, osteophytes may occur at the dorsal rim of the distal radius or dorsal aspects of the scaphoid or lunate. Most cases resolve with splinting, rest and anti-inflammatory medication or injection. Wrist arthroscopy with debridement of synovium is helpful in refractory cases. 

Dr Mohan is a registrar in orthopaedics, Southampton General Hospital, Southampton

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