Wrist injuries are common in sports and can have a major impact on performance. Wrist injuries can occur due to do a traumatic event such as a fall on an outstretched hand or from overuse. Wrist injuries are often misdiagnosed or even dismissed if no clear structural damage is found on an x-ray. This can lead to mismanagement of the injury resulting in a delay in return to sport and chronic wrist pain. Most athletes will report pain and swelling on the back of the wrist that progressively gets worse with loading, rotation, and extension. Wrist injuries are commonly seen in gymnastics, diving, weightlifting, fencing and racquet sports.
Traumatic Wrist injuries
Traumatic wrist injuries usually occur due to direct force applied to the wrist and include distal radius growth plate injury, scapholunate ligament injury or carpal boss.
Distal radius injury
Distal radius injuries occurring at the growth plate are most likely to be seen during growth spurts. Athletes should consider using a brace to limit excessive loading in extension as soon as dorsal wrist pain is identified. Continuous loading into the wrist can lead to premature growth plate closure of the radius, which results in ulnar positive variance and can cause ulnar-sided wrist pain. Ulnar positive variance occurs when the ulna is longer than the radius, placing increased pressure into the TFCC especially with wrist extension and rotation into palm down position.
Scapholunate ligament injury
Scapholunate ligament injuries are a result of carpal instability and, if left untreated, can result in a carpal collapse. Scapholunate injuries usually present with dorsal wrist pain while loading into extension (i.e. push ups) or with sustained grip, as well as with clicking or popping with wrist movement.
A carpal boss is a bony prominence that forms between the base of the second and third metacarpal as a result excessive loading of the wrist. This bony prominence can be felt when in flexion. If treated acutely, it may be managed with a wrist brace. However, if it becomes chronic, surgery to remove the bone may be required.
In all these cases, wrist immobilization outside of sports with a custom thermoplastic orthosis and wrist support using taping or soft bracing during sports are important to rest the tissues and prevent further structures from being damaged.
Overuse wrist injuries
Overuse wrist injuries occur due to repetitive patterns of movement causing microtears in the tissue. These would include De Quervain’s tenosynovitis, intersection syndrome, Extensor Carpi Ulnaris (ECU) Tendonitis and Extensor Pollicis Longus (EPL) tendonitis.
De Quervain’s tenosynovitis
De Quervain’s tenosynovitis is commonly seen in athletes playing racquet sports or fencing with repetitive movement into ulnar deviation (wrist moving towards the small finger). De Quervain’s is a result of inflammation within the first extensor compartment, involving extensor pollicis brevis and abductor pollicis longus, commonly diagnosed by positive Finkelstein test. Pain is felt on the thumb side of the wrist and is often described as a hot burning wrist pain.
Intersection syndrome is relatively uncommon but can occur with repetitive flexion, extension and radial deviation. It is the result of inflammation between the first and second extensor compartments. Athletes will have pain with wrist movement, swelling over the forearm and, occasionally, a squeaking sound may be heard.
EPL tendonitis is a result of the EPL tendon (the tendon that extends the tip of your thumb) being impinged between the third metacarpal and lister tubercle (a normal small bony prominence on the dorsal aspect of the radius). This often occurs in gymnasts or divers with excessive loading into wrist extension. Pain can be exacerbated by moving the wrist and thumb into flexion resulting in over stretching of the EPL tendon.
ECU tendonitis is commonly seen in golfers or tennis players due to the repetitive motion of wrist flexion and ulnar deviation in a supinated (palm up) position. When an athlete is experiencing tendonitis, it is important to rest the involved tissue using an orthosis for 4 to 6 weeks, followed by slowly progressing range of motion and then strengthening.
Hand physiotherapy for wrist injuries
For all athletes, our main goal is to get them back to sport free from pain. Athletes who experience wrist pain during their sport should be assessed by a Certified Hand Therapist to determine the exact cause and be treated accordingly. Conservative treatment often starts with a period of immobilization via a custom thermoplastic orthosis to settle acute inflammation and pain. During the initial immobilization phase, the focus is on proximal upper extremity (shoulder, elbow) and core strengthening. After the immobilization phase, the focus moves on to regaining range of motion, improving wrist proprioception and stability, strengthening and restoring sport specific movement patterns. The length of time an athlete will be sidelined depends on the demands placed on the wrist during their sport, the ability to wear a soft brace while playing and the length of time since the wrist pain has been of concern.
If you are experiencing wrist pain that is affecting your sport performance or any other activities that are important to you, you should have it assessed as soon as possible to avoid developing a chronic injury. Our Certified Hand Therapists and Sports Physiotherapist have the perfect combination of skills to get you back to your sport as soon as possible. Reach out to get started with sports physiotherapy in Edmonton!
Campbell, D., Campbell, R., O’Connor, P., & Hawkes, R. (2013). Sports- related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury, and management. British Journal of Sports Medicine, 47, 1105-1111.
DiFiori, J.P. (2006). Overuse injury and the young athlete: the case of Chronic Wrist Pain in Gymnasts. Currents Sports Medicine Reports, 5, 165-167.
Hanson, Z.C. & Lourie, G.M. (2022). Middorsal wrist pain in the high- level athlete. The Orthopaedic Journal of Sports Medicine, 10(4), 1-11.
Trevithick, B., Mellifont, R., & Sayers, M. (2020). Wrist pain in gymnasts: Efficacy of a wrist brace to decrease wrist pain while performing gymnastics. Journal of Hand Therapy, 33, 354-360.
Benjamin, H.J., Engel, S.C. & Chudzik, D. (2017). Wrist Pain in Gymnasts: A review of common overuse wrist pathology in the Gymnastics Athlete. Currents Sports Medicine Reports, 16(5), 322-329.