Dorsal Wrist Pain in the Extended Wrist-Loading Position: An MRI Study

Abstract

Background The etiology of dorsal wrist pain associated with loading of the wrist in extension has not been clearly identified in the literature. Purpose Many exercise disciplines incorporate upper extremity weight-bearing exercises in an extended wrist posture, for example push-ups, plank position, and various yoga and Pilates poses. This study evaluates patients with dorsal wrist pain in the extended wrist-loading position and identifies anatomic abnormalities in the wrist using magnetic resonance imaging (MRI). Methods A retrospective chart review was performed comparing MRI of patients who complained of dorsal wrist pain while performing weight bearing in a wrist extension position with a control group of patients who complained of ulnar-sided wrist pain. The primary MRI outcome was dorsal wrist pathology, including occult dorsal ganglion cyst, scapholunate ligament tear or degeneration, and dorsal capsulitis. Results Dorsal wrist pathology was significantly more prevalent in patients with dorsal wrist pain (84%) than in the patient cohort with ulnar-sided wrist pain (12%). Occult dorsal ganglion cysts were the most common sources of pathology (76%). Conclusion MRI demonstrated an identifiable dorsal abnormality in 84% of patients with dorsal wrist pain associated with weight bearing on the extended wrist. Occult dorsal ganglion cysts are the most common cause of dorsal wrist pain, followed by partial scapholunate tears. When patients complain of dorsal wrist pain during specific extended loading wrist positions such as push-ups, yoga, or Pilates poses, an MRI may be warranted to help identify anatomic abnormalities that may help guide treatment choices. Level of Evidence Diagnostic, Level III.

Keywords: dorsal ganglion; dorsal wrist pain; imaging; wrist loading.

Fig. 1

Dorsal wrist pathologies identified using MRI in patient cohort reporting dorsal wrist pain with extended lead-bearing wrist position.

Fig. 2

MRI coronal inversion recovery (A) and axial proton density (B) images of the right wrist of a 35-year-old man shows a large ganglion cyst measuring up to 21 mm in greatest dimension within the dorsal soft tissues arising from the dorsal band of the scapholunate ligament. L, lunate; S, scaphoid, and arrows point to the cyst arising from the scapholunate ligament.

Fig. 3

MRI coronal inversion recovery image of the right wrist of a 40-year-old man shows a tear (arrow) of the membranous portion of the scapholunate ligament.

Fig. 4

Dorsal wrist pathologies identified using MRI in patient cohort reporting ulnar wrist pain.