Antibiotic Use and Tendon Injury – Is there a link?
Wrist pain is a relatively common complaint at our clinic. There are various causes of wrist pain and there are different structures around the wrist and hand that can be involved. Some of the relatively common conditions include carpal tunnel syndrome, wrist sprain, DeQuervain’s tenosynovitis, cartilage injuries, arthritis and various repetitive strain injuries of the wrist and hand. For today’s blog, we’ll summarize a relatively new diagnosis; extensor retinaculum impingement in the wrist.
Wrist Pain Diagnosis
The wrist can sometimes be a tricky area for clinicians to diagnose. A thorough history is essential, including some background information on how the injury started. For example, many wrist injuries are caused by repeated bending while weight bearing (such as doing a push up). Extensor retinaculum impingement is one of these conditions. Let’s first outline the anatomy of this area…
Anatomy of the Wrist
Wrist and finger flexors are muscles on the front of our forearm that cross the wrist joint. They bend the wrist and fingers forward, in the direction of a grip. Our extensors do the opposite. They are on the back of our forearm and wrist and they act to extend the wrist (like the movement of a backhand) and open up from a grip. We all have some “extra” connective tissue on the back of the wrist and hand that covers some of these extensor tendons. This is the area implicated in extensor retinaculum impingement of the wrist (one of many causes for wrist pain).
Wrist Impingement
Wrist Extension
When the wrist is placed into extension, friction and pressure can increase in the area of the extensor retinaculum. This can be even worsened when we have the wrist in this position while weight bearing (like doing a push up). With extensor retinaculum impingement, the pain is usually located on the back of the wrist. This condition usually causes pain with pressure over the area and an increase in pain with wrist extension. The wrist might be swollen. (For the practitioners out there – pain will usually be present with the patient in hyperextension and resisting finger extension. X-rays are usually not helpful to identify this condition, but may be helpful in ruling out other causes of wrist pain).
Wrist Pain Treatment
The treatment of this type of wrist pain depends on the specific case. If swelling is present, ice and modalities to decrease inflammation might be helpful. In more chronic cases, soft tissue therapy like active release or the graston technique might be useful. Acupuncture may also provide benefit to those with this type of wrist pain. As with most conditions, the best treatment approach cannot be determined until a thorough history and examination are performed. Are you experiencing wrist pain? Give us a call!
Written by: Dr. Kevin McIntyre
References
VanHeest AE et al. Extensor retinaculum impingement in the athlete: a new diagnosis. American Journal of Sports Medicine 2007; 35(12):2126-2130.
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