New Discovery About Wrist Pain in AthletesAccording to this new study, extensor retinaculum impingement may be the source of wrist pain in certain athletes. The extensor retinaculum is a band of fibrous tissue across the back of the wrist. It covers the extensor tendons of the fingers and thumb. Impingement is another word for pinching.
Overuse of the wrist into a position of extension can cause impingement. Increased friction and pressure lead to pinching of the extensor retinaculum onto the tendons. Athletes at greatest risk include platform divers and gymnasts. Athletes who participate in the shot put event in track and field are also at risk.
The medical records of seven athletes with symptoms in eight wrists were reviewed. Symptoms included wrist pain and tenderness across the back of the hand. This site corresponded to the location of the extensor retinaculum. The painful symptoms were made worse by hyperextending the wrist.
Swelling was present and all seven athletes had a positive provocative test. This test is done by extending the wrist as far as possible. Then resistance is given to the fingers while the patient tries to bend the fingers back further. A positive test occurs when pain is brought on by this position with resisted motion.
Patients were treated with conservative care at first. This included rest, ice, and antiinflammatory drugs. Steroid injection was another option. The two athletes who were treated by injection returned to their previous level of sports without any further pain.
Most of the athletes wanted to get back to their sport as quickly as possible. They chose surgery instead. The surgeon cut a portion of the retinaculum and released the synovial covering over the tendons. It was believed that these were keeping them from moving freely.
The athletes who had surgery were also able to return to full participation in their sport. They did not have any return of their symptoms. After recovery from the operation, the provocative test was negative.
During the procedure, the surgeon was able to see thickening of the retinaculum. Swelling and inflammation of the lining around the tendons was also present. This is called tenosynovitis. The authors then compared their findings with the anatomy from 10 cadavers. A cadaver is a body preserved after death for study.
They found that half of the cadaver wrists had signs of retinaculum thickening. This thickening may be a risk factor for developing the impingement syndrome. Athletes who repeatedly hyperextend the wrist while loading it with their body weight may turn the predisposed wrist into a problem.
Ann E. VanHeest, MD, et al. Extensor Retinaculum Impingement in the Athlete. A New Diagnosis. In The American Journal of Sports Medicine. December 2007. Vol. 35. No. 12. Pp. 2126-2130.
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