Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment and Early Return to Play
Hanson, ZC and Lourie, GM..
Orthopaedic Journal of Sports Medicine (2022) Vol. 10: 4.
Wrist injuries in high-level athletes, although common, often lack the attention or urgency for care as do injuries in the shoulder, knee and ankle. The evaluation, triage and management of these injuries are relatively standard, particularly those sustained acutely. And unlike radial and ulnar sided wrist injuries, an understanding of middorsal injuries could be improved. Wrist injuries specific to this location often present as early insidious discomfort that, with examination and care that lack detail, leads to lingering pain and inability to perform. This open access paper reviews the differential diagnoses of middorsal wrist pain in high-level athletes, along with treatment and return to play and is summarized below.
Do note that this summary does not include my own personal thought processes (i.e. assessment upstream) and choices for plan of management (i.e. manual therapies and/or exercise rehabilitation strategies). Summarizing this paper was simply a means for me to keep myself abreast of the multitude of possibilities when presented with athletes experiencing middorsal wrist pain.
TRAUMATIC AND OVERUSE INJURIES
Scapholunate Ligament Injuries
Second and Third Carpometacarpal Injuries
Distal Radial Physeal Stress Syndrome
Avascular Necrosis of the Lunate
TENDINOPATHY AND TENDON INSTABILITY
Extensor Pollicis Longus Tenosynovitis
Extensor Carpi Radialis Brevis Insertional Tendinitis
Fourth-Compartment Syndrome: Anomalous Muscles and Tenosynovitis
DORSAL IMPINGEMENT SYNDROMES
Dorsal Capsular Impingement
Occult Dorsal Carpal Ganglion
Dorsal Posterior Interosseous Nerve Syndrome
It is clear that structures within this region are numerous and nuanced. It should also be clear that specificity of management warrants specificity of diagnosis. As such, it is incumbent upon ourselves as clinical practitioners to have a detailed understanding of the differential diagnoses within this region regardless of our scope of practice. And although many more differentials exist in the areas surrounding the middorsal region, as well as those pertaining to non-traditional orthopaedic pathways, this paper provides us with a good overview to help maintain a vast array of possible scenarios when presented with wrist pain in high level athletes.