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Extensor Retinaculum Impingement in the Athlete

A New Diagnosis

Ann E. VanHeest, MD^,*, Nancy M. Luger, James H. House, MD and Michael Vener, MD

From the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, and Glacial Lakes Orthopaedics, Watertown, South Dakota

^* Address correspondence to Ann E. VanHeest, MD, Department of Orthopaedic Surgery, 2450 Riverside Ave, Suite R200, Minneapolis, MN 55454 (e-mail: vanhe003{at}umn.edu).

Background: Athletes with repetitive weightbearing hyperextension activities are predisposed to wrist pain.

Purpose: To describe extensor retinaculum impingement of the extensor tendons as a new diagnosis for wrist pain for the athlete performing repetitive wrist hyperextension, to present cadaveric dissections to further understand the anatomical basis for extensor retinaculum impingement, and to report treatment outcomes of extensor retinaculum impingement.

Study Design: Case series; Level of evidence, 4.

Methods: A retrospective chart review was performed for athletes treated from 1987 to 2006 for wrist pain due to extensor retinaculum impingement. Eight wrists in 7 athletes were reviewed with a mean presenting age of 19.6 years. The hallmark symptom was dorsal wrist pain, and signs were extensor tendon synovitis and tenderness at the distal border of the extensor retinaculum, provoked by wrist hyperextension. Ten cadaveric wrists were dissected and examined to evaluate anatomical factors that may contribute to extensor retinaculum impingement.

Results: Two athletes (2 wrists) were treated with corticosteroid injections. Five patients (6 wrists) were treated operatively, with pathologic findings of thickening of the distal border of the extensor retinaculum and concomitant extensor tendon synovial thickening or, in 1 patient, tendon rupture. Partial distal resection of the extensor retinaculum was performed to eliminate impingement. All patients had complete relief of pain and full return to sport.

Conclusion: Competitive sports that require repetitive wrist extension with an axial load predispose the athlete to extensor retinaculum impingement. Athletes with dorsal wrist pain and tenosynovial thickening worsened with wrist hyperextension should be considered for the diagnosis of extensor retinaculum impingement. When nonoperative management fails, surgical resection of the distal impinging border of the extensor retinaculum can eliminate pain and can still allow athletes to return to sport without diminishing the opportunity for significant athletic accomplishments.

Key Words: extensor retinaculum • impingement • wrist pain • tenosynovitis