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Over-trained athletes at risk for new wrist impingement disorder

Cortisone injections may effectively treat extensor retinaculum impingement in some cases, but most may require surgical release.

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WASHINGTON, D.C. — Orthopedic hand surgeons should consider the new diagnosis of extensor retinaculum impingement in over-trained athletes with dorsal wrist pain, according to a study presented here.

If conservative treatment fails in these patients, a partial distal resection of the extensor retinaculum can relieve pain and allows patients to return to sport, said Nancy M. Luger, MD, a first-year resident at the University of Minnesota in Minneapolis. She presented the study results here at the Adrian E. Flatt Residents and Fellows Conference in Hand Surgery held during the American Society for Surgery of the Hand 61st Annual Meeting.

Luger and colleagues conducted a retrospective chart review on seven athletes (eight wrists) treated for this diagnosis between 1987 and 2006. This included five women and two men with an average age of 19.6 years.

Surgeons diagnosed patients with extensor retinaculum impingement after a positive provocative test and excluding any underlying wrist disorders, according to the study.

Researchers found that the most at-risk athletes included those in competitive sports that require repetitive wrist extension with an axial load. Such sports include gymnastics with vaulting and floor exercises, track and field, discus throwing and platform diving, Luger said.

Additionally, the researchers found that cortisone injections were successful in two patients. Surgical release of the extensor retinaculum was successful in the remaining six wrists of five patients, she said.

In one patient with an extensor pollicis longus tendon rupture, a surgeon performed an extensor indicis proprius tendon transfer in conjunction with the retinaculum release. Another patient had bilateral dorsal ganglions removed during the resection, according to the study.

"All patients were pain free from either their nonoperative or operative treatment," Luger said. "Their athletic accomplishments were still achieved. Three patients won a collegiate championship and one of the patients went on to become an Olympic medalist."

For more information:

• Luger NM, VanHeest AE, House JH, et al. Extensor retinaculum impingement in the athlete: A new diagnosis. Presented at the Adrian E. Flatt Residents and Fellows Conference in Hand Surgery, American Society for Surgery of the Hand 61st Annual Meeting. Sept. 6, 2006. Washington, D.C.