Dorsal wrist impaction syndrome is pain at the back of the wrist caused by repeated pressure on the joint when it is bent fully backwards under load, such as in push-ups, handstands, yoga or weightlifting.
When you put weight through your hand with the wrist bent back, the bones at the back of the wrist are pressed together. Doing this again and again can pinch the joint lining and capsule, and bruise or irritate the edges of the bones. This is called dorsal wrist impaction syndrome. Over time, the joint lining may become thickened and inflamed, and small bone spurs can form at the back of the wrist.
It is common in gymnasts, weightlifters, people who do high-intensity functional training, climbers and people who do a lot of push-ups, planks or yoga poses such as downward dog. In young gymnasts, the growth plate at the end of the forearm bone can also be affected. Other wrist problems, such as a hidden ganglion or a ligament injury, can cause similar pain and are checked for during assessment.
The doctor asks about your training and symptoms and examines the wrist, including its range of movement, grip strength and the exact area of tenderness. Tests help rule out other causes such as a ligament injury.
Where it helps, an ultrasound scan can look for thickening of the joint lining, fluid, a hidden ganglion or tendon problems at the back of the wrist.
X-rays can show bone spurs, wrist alignment and growth plate changes in younger athletes. An MRI can be arranged by referral to look for bone bruising, cartilage or ligament injury.
If a ligament injury is found, or symptoms continue despite treatment, the clinic can refer you to a hand surgeon.
Your plan depends on what the assessment finds. These are the options we most often discuss.
Reducing weight-bearing on the bent-back wrist often helps symptoms settle. Options include doing push-ups on your fists or on handles, using a wedge under the heel of the hand, and adjusting grip in lifts.
Taping or a wrist support that limits how far the wrist bends back may help reduce pain during training.
Learn moreA graded programme to strengthen the forearm and grip, improve wrist control and gradually rebuild tolerance to weight-bearing is a key part of treatment.
Learn moreGentle hands-on mobilisation of the wrist joints may help improve movement and comfort in some people, alongside exercises.
Learn moreWhere there is thickening and inflammation of the joint lining, an ultrasound-guided injection may reduce pain for a period, where assessed as suitable. It is used alongside rehabilitation and activity changes.
Learn moreIf symptoms persist despite good non-surgical care, or there are bone spurs or a ligament injury, the clinic will refer you to a hand surgeon to discuss options such as keyhole surgery.
Many people improve over six to twelve weeks with changes to training and a regular exercise programme. A gradual return to full weight-bearing on the bent-back wrist is usually built up over this time, and some people need longer. Young gymnasts with growth plate irritation often need a longer break from weight-bearing on the hands. If bone spurs or a ligament injury are present, recovery can take longer and time frames vary.
Often yes, with changes. Doing push-ups on your fists or on handles, and using a wedge or folded mat under the heel of your hand in yoga, can reduce how far the wrist bends back. Your doctor can advise how much to do while your wrist settles.
No, but a small ganglion hidden under the skin at the back of the wrist can cause similar pain. An ultrasound scan can help tell them apart. The two can also occur together.
In children and teenagers, the growth plate at the end of the forearm bone takes a lot of stress during gymnastics. Repeated overload can irritate it, and ongoing pain should be assessed. A period of rest from weight-bearing on the hands is often needed.
Usually not. A support or tape is often used during training to limit how far the wrist bends back. Wearing it all day may lead to stiffness and weakness, so your doctor will advise when to use it.
No. Inflexion Clinic is a private GP clinic, so you can book directly. Book online or call the clinic on +65 8997 0659.
Our clinicians will take a proper history, examine you, and give you a clear plan on the day.