Pain at the back of the wrist is common, affecting both athletes and office workers. One often under-recognised cause is dorsal wrist impingement syndrome. It occurs when the soft tissues at the back of the wrist become trapped or compressed as the wrist bends backwards. So what is dorsal wrist impingement, and how do we treat it?
What is dorsal wrist impingement syndrome?
When the wrist bends backwards (extends), the soft tissues at the back of the joint are compressed. In dorsal wrist impingement, the joint lining (capsule) becomes thickened and gets pinched between the wrist bones during this movement — most often in the region of the lunate and capitate bones.
Repetitive, forceful wrist extension under load is the driver. That’s why it’s common in sports that load the wrist in extension — gymnastics, weightlifting, tennis, and CrossFit — particularly in people who are naturally hypermobile.
Symptoms of dorsal wrist impingement
The main feature is pain at the back of the wrist, especially when extending the wrist or putting weight through it. Typical symptoms include:
- Dorsal wrist pain, worse with extension and weight-bearing
- Pain in positions such as a push-up or handstand, or pushing up from a chair
- Stiffness after repetitive wrist movements, or sports that load the hands
- Sometimes a catching or clicking sensation with wrist extension
How is dorsal wrist impingement diagnosed?
Examination focuses on reproducing the pain and pinpointing the tenderness.
- Palpation — tenderness is usually present at the back of the wrist, between the end of the radius and the carpal bones (commonly the lunate and capitate region).
- Pain with extension — symptoms are brought on when the wrist bends fully backwards, particularly against resistance or when weight-bearing, such as in a push-up position or handstand.
Imaging mainly helps exclude other causes and supports the diagnosis. X-rays check for bony causes, while ultrasound and MRI show the thickened capsule and any inflammation, and rule out the alternatives.
Conditions that mimic dorsal wrist impingement
Several other conditions cause pain at the back of the wrist and need to be excluded:
- A ganglion cyst, including a small (occult) one
- Gymnast’s wrist (distal radial epiphysitis) in younger athletes
Treatment of dorsal wrist impingement
Management depends on the severity and your activity level. We start with conservative treatment.
- Activity modification — avoiding the painful loading positions, such as push-ups and handstands, while the wrist settles.
- Rest and splinting — a wrist splint rests the joint and limits the provocative extension.
- Physiotherapy — restoring movement, then strengthening the wrist and forearm, and correcting technique and any contributing biomechanics.
- Anti-inflammatory measures — ice and anti-inflammatory medication for pain and swelling.
When dorsal wrist pain symptoms persist, an ultrasound-guided cortisone injection into the impingement tissue reduces inflammation and helps rehabilitation progress. Placed precisely under ultrasound guidance, it targets the thickened capsule while avoiding the surrounding tendons and nerves.
Surgery is reserved for the small number of cases that don’t respond to other treatments. Keyhole surgery (arthroscopy) removes the thickened, impinging tissue at the back of the wrist.
How much does a wrist injection cost?
Dr Masci injects at a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about dorsal wrist impingement
What does dorsal wrist impingement feel like?
Pain at the back of the wrist that comes on when you bend the wrist backwards or put weight through it — in a push-up, a handstand, or pushing up from a chair. There may be stiffness afterwards, and sometimes a catch or click with extension. The pain eases with rest and returns with loading.
Can dorsal wrist impingement heal without surgery?
Yes — most cases do. Activity modification, splinting, physiotherapy, and, where needed, an ultrasound-guided injection settle the great majority. Surgery to remove the impinging tissue is reserved for the few that don’t respond to a proper conservative programme.
Why is it common in gymnasts and weightlifters?
Because their sports repeatedly load the wrist in full extension — handstands, tumbling, presses, and holds. That repeated compression at the back of the wrist irritates and thickens the joint capsule, which then gets pinched on extension. Naturally hypermobile people are more prone to it.
How is it different from a wrist ganglion or gymnast’s wrist?
All three cause back-of-wrist pain. A ganglion cyst is a fluid-filled lump, sometimes too small to see. Gymnast’s wrist is a growth-plate injury in young athletes. Dorsal impingement is a soft-tissue pinching of the capsule. Examination and imaging — ultrasound or MRI — distinguish them, which matters because the treatments differ.
How long does it take to settle?
Recovery is usually measured in weeks to a few months with load management and rehabilitation. Returning to loaded wrist extension too soon tends to prolong it, so a graded, symptom-guided return is important.
Final word from Sport Doctor London about dorsal wrist impingement
Dorsal wrist impingement syndrome is an under-recognised cause of pain at the back of the wrist, particularly in athletes who load the wrist in extension. The good news is that most cases settle with activity modification, rehabilitation, and — where needed — an accurate ultrasound-guided injection. Surgery is rarely necessary. The key is an accurate diagnosis that excludes the other causes of dorsal wrist pain.
If you have persistent pain at the back of your wrist, Dr Masci can assess you in London, including in-clinic ultrasound. Contact the team here or call +44 (0) 203 488 0350.
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