Dorsal Wrist Impingement

Pain in the back of the wrist is a common issue affecting both athletes and office workers. One potential but often under-recognised cause is dorsal wrist impingement syndrome. This condition occurs when soft tissues on the back (dorsal aspect) of the wrist become trapped or compressed during movement of the wrist backwards. For people who report pain at the back of the wrist, dorsal wrist impingement should always be considered a possible diagnosis. 

Symptoms of Dorsal Wrist Impingement

The main feature of dorsal wrist impingement syndrome is pain at the back of the wrist, especially when extending the wrist or putting weight through it.

Typical symptoms include:

• Localised pain on the back of the wrist, often central

• Pain aggravated by the wrist being bent backwards, such as in a push-up or handstand

• Swelling or tenderness over the dorsal wrist joint

• Stiffness after repetitive wrist movements or sports involving loading through the hands (e.g. gymnastics, weightlifting, tennis or CrossFit)

In some cases, patients also describe a catching or clicking sensation with wrist extension.

Clinical Examination

Examination of the wrist focuses on reproducing the pain and localising tenderness.

• Palpation: Tenderness is usually present on the dorsal aspect of the wrist, between the end of the radius and carpal bones (commonly the lunate and capitate region).

• Pain with extension: Symptoms are aggravated when the wrist is bent backwards fully, particularly against resistance or when weight-bearing (e.g. push-up position, handstands).

Other causes of dorsal wrist pain, such as scapholunate ligament injury, ganglion cyst, bone stress fracture, Kienbock’s disease, or wrist arthritis, should be ruled out during examination.

A detailed clinical exam is essential because dorsal wrist impingement can mimic other injuries.

Imaging for Dorsal Wrist Impingement

• X-rays are often normal but may be used to rule out bony injury or arthritis.

• MRI can be helpful in visualising soft tissues and assessing for synovitis, ligament injury, or cartilage changes.

• Dynamic ultrasound may reveal thickening or impingement of the capsule with wrist extension, guiding targeted injections to the affected area.

Imaging primarily helps exclude other causes of dorsal wrist pain while supporting the diagnosis of dorsal wrist impingement syndrome.

Treatment Options

Management of dorsal wrist impingement depends on severity and patient activity level.

Conservative treatment is the first approach and includes:

• Activity modification – avoiding painful loading positions such as push-ups or handstands

• Rest and splinting – using a wrist splint to reduce repetitive extension

• Physiotherapy – focusing on mobility, strengthening and gradual load tolerance

• NSAIDs – to reduce pain and inflammation

Most cases will resolve in 2-3 months with conservative management. 

Injection therapy:

• Ultrasound-guided corticosteroid injections into the dorsal wrist capsule can reduce inflammation and provide targeted relief. About 70% of cases will respond to a localised cortisone injection into the dorsal capsule. 

• In some cases, hyaluronic acid or PRP injections may be considered for ongoing pain.

Surgical treatment:

• Reserved for patients with persistent symptoms.

• Keyhole surgery may relieve symptoms by removing the impinging tissue and bony spurs. Surgery is a safe and effective treatment for pain relief and helping a return to sport. 

Final Word from Sportdoctorlondon regarding Dorsal Wrist Impingement Syndrome

Dorsal wrist impingement syndrome is a frequently overlooked cause of wrist pain, particularly in athletes and active individuals who load the wrist into extension. A careful clinical assessment, combined with imaging, allows for an accurate diagnosis. Most patients respond well to simple measures, though injections and, rarely, surgery may be required for persistent cases.