Traumatic and Overuse Wrist Injuries: Osseous and Tendon Pathologies

Abstract

Traumatic and overuse injuries of bones and tendons of the wrist represent a significant proportion of the musculoskeletal disorders encountered in both athletic and occupational settings. Conventional radiography remains the first-line imaging modality for osseous trauma, but it can miss up to a third of scaphoid and hamate fractures. Computed tomography is superior for characterizing occult or nondisplaced fractures. Magnetic resonance imaging provides important information on occult fractures, overuse injuries of osseous structures, and tendinous abnormalities.

A comprehensive understanding of wrist injuries is essential to ensure accurate and timely diagnosis, in turn facilitating the selection of appropriate patient-specific treatment strategies. By minimizing diagnostic delays, clinicians can reduce the risk of adverse sequelae such as chronic instability, degenerative joint changes, and functional impairment. The implementation of optimized diagnostic and therapeutic pathways not only lessens the long-term burden of disability for patients, but it also plays a crucial role in enabling a safe and efficient return to both occupational duties and sporting activities.

Keywords

overuse - tenosynovitis - trauma - sports imaging - wrist

Publikationsverlauf

Eingereicht: 16. Oktober 2025

Angenommen: 21. November 2025

Artikel online veröffentlicht:
02. Februar 2026

• References

• 1 Bergfeld JA, Weiker GG, Andrish JT, Hall R. Soft playing splint for protection of significant hand and wrist injuries in sports. Am J Sports Med 1982; 10 (05) 293-296
• 2 Buterbaugh GA, Brown TR, Horn PC. Ulnar-sided wrist pain in athletes. Clin Sports Med 1998; 17 (03) 567-583
• 3 Barr AE, Barbe MF, Clark BD. Work-related musculoskeletal disorders of the hand and wrist: epidemiology, pathophysiology, and sensorimotor changes. J Orthop Sports Phys Ther 2004; 34 (10) 610-627
• 4 Lisle DA, Shepherd GJ, Cowderoy GA, O'Connell PT. MR imaging of traumatic and overuse injuries of the wrist and hand in athletes. Magn Reson Imaging Clin N Am 2009; 17 (04) 639-654 , vi
• 5 Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of sports-related hand and wrist injuries: sports imaging series. Radiology 2016; 279 (03) 674-692
• 6 Rettig AC. Elbow, forearm and wrist injuries in the athlete. Sports Med 1998; 25 (02) 115-130
• 7 Geissler WB. Carpal fractures in athletes. Clin Sports Med 2001; 20 (01) 167-188
• 8 Rettig AC. Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist. Am J Sports Med 2003; 31 (06) 1038-1048
• 9 Beeres FJP, Hogervorst M, Den Hollander P, Rhemrev SJ. Diagnostic strategy for suspected scaphoid fractures in the presence of other fractures in the carpal region. J Hand Surg [Br] 2006; 31 (04) 416-418
• 10 Maris S, Apergis E, Apostolopoulos A. et al. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC): a review of treatment options for stage II. Cureus 2024; 16 (04) e59014
• 11 Panagis JS, Gelberman RH, Taleisnik J, Baumgaertner M. The arterial anatomy of the human carpus. Part II: the intraosseous vascularity. J Hand Surg Am 1983; 8 (04) 375-382
• 12 Fowler JR, Hughes TB. Scaphoid fractures. Clin Sports Med 2015; 34 (01) 37-50
• 13 Tessaro MO, McGovern TR, Dickman E, Haines LE. Point-of-care ultrasound detection of acute scaphoid fracture. Pediatr Emerg Care 2015; 31 (03) 222-224
• 14 Platon A, Poletti P-A, Van Aaken J. et al. Occult fractures of the scaphoid: the role of ultrasonography in the emergency department. Skeletal Radiol 2011; 40 (07) 869-875
• 15 Chianca V, Di Pietto F, Zappia M, Albano D, Messina C, Sconfienza LM. Musculoskeletal ultrasound in the emergency department. Semin Musculoskelet Radiol 2020; 24 (02) 167-174
• 16 Guo RC, Cardenas JM, Wu CH. Triquetral fractures overview. Curr Rev Musculoskelet Med 2021; 14 (02) 101-106
• 17 Hauck RM, Skahen III J, Palmer AK. Classification and treatment of ulnar styloid nonunion. J Hand Surg Am 1996; 21 (03) 418-422
• 18 Protopsaltis TS, Ruch DS. Triangular fibrocartilage complex tears associated with symptomatic ulnar styloid nonunions. J Hand Surg Am 2010; 35 (08) 1251-1255
• 19 Chianca V, Curti M, Riegger M, Del Grande F. Imaging of fatigue fractures in the adult athlete. Semin Musculoskelet Radiol 2025; 29 (03) 357-365
• 20 Saunier J, Chapurlat R. Stress fracture in athletes. Joint Bone Spine 2018; 85 (03) 307-310
• 21 Blum AG, Zabel JP, Kohlmann R. et al. Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics 2006; 26 (04) 1021-1044
• 22 Pepper M, Akuthota V, McCarty EC. The pathophysiology of stress fractures. Clin Sports Med 2006; 25 (01) 1-16 , vii
• 23 Arnaiz J, Piedra T, Cerezal L. et al. Imaging of Kienböck disease. AJR Am J Roentgenol 2014; 203 (01) 131-139
• 24 Bae JY, Shin YH, Choi SW, Moon SH, Park HS, Kim JK. A novel classification of Kienbock's disease based on magnetic resonance imaging. Int Orthop 2023; 47 (08) 2023-2030
• 25 Kalainov DM, Cohen MS, Hendrix RW, Sweet S, Culp RW, Osterman AL. Preiser's disease: identification of two patterns. J Hand Surg Am 2003; 28 (05) 767-778
• 26 Schmitt R, Fröhner S, van Schoonhoven J, Lanz U, Gölles A. Idiopathic osteonecrosis of the scaphoid (Preiser's disease)—MRI gives new insights into etiology and pathology. Eur J Radiol 2011; 77 (02) 228-234
• 27 Roh YH, Kim S, Gong HS, Baek GH. Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome. Sci Rep 2018; 8 (01) 9891
• 28 Xu W, Ho PC, Nakamura T. et al. Guidelines for the diagnosis and treatment of ulnar impaction syndrome (2024). J Wrist Surg 2024; 14 (01) 2-13
• 29 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (01) 126-129
• 30 Woitzik E, deGraauw C, Easter B. Ulnar impaction syndrome: a case series investigating the appropriate diagnosis, management, and post-operative considerations. J Can Chiropr Assoc 2014; 58 (04) 401-412
• 31 Nakamoto JC, Althoff BF, Abarca Herrera AK, Escudero RB. Hamatolunate impingement, a differential diagnosis of ulnar-sided wrist pain. J Hand Microsurg 2024; 16 (03) 100049
• 32 Imaeda T, Nakamura R, Shionoya K, Makino N. Ulnar impaction syndrome: MR imaging findings. Radiology 1996; 201 (02) 495-500
• 33 Krishnamurthy HA, Gowda H, Parameshwara PB, Raju P A, Mudunuri S, Parihar P. Carpal boss: a case series of a radiological enigma in dorsal wrist pathology. Cureus 2024; 16 (08) e68078
• 34 Nevalainen MT, Roedl JB, Morrison WB, Zoga AC. MRI of a painful carpal boss: variations at the extensor carpi radialis brevis insertion and imaging findings in regional traumatic and overuse injuries. Skeletal Radiol 2019; 48 (07) 1079-1085
• 35 Shahabpour M, Abid W, Van Overstraeten L, De Maeseneer M. Wrist trauma: more than bones. J Belg Soc Radiol 2021; 105 (01) 90
• 36 Kleinert HE, Verdan C. Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am 1983; 8 (5 Pt 2): 794-798
• 37 Khan KM, Cook JL, Bonar F, Harcourt P, Åstrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 1999; 27 (06) 393-408
• 38 Rees JD, Wilson AM, Wolman RL. Current concepts in the management of tendon disorders. Rheumatology (Oxford) 2006; 45 (05) 508-521
• 39 Clavero JA, Golanó P, Fariñas O, Alomar X, Monill JM, Esplugas M. Extensor mechanism of the fingers: MR imaging-anatomic correlation. Radiographics 2003; 23 (03) 593-611
• 40 Llopis E, Restrepo R, Kassarjian A, Cerezal L. Overuse injuries of the wrist. Radiol Clin North Am 2019; 57 (05) 957-976
• 41 Ashraf MO, Devadoss VG. Systematic review and meta-analysis on steroid injection therapy for de Quervain's tenosynovitis in adults. Eur J Orthop Surg Traumatol 2014; 24 (02) 149-157
• 42 Giovagnorio F, Andreoli C, De Cicco ML. Ultrasonographic evaluation of de Quervain disease. J Ultrasound Med 1997; 16 (10) 685-689
• 43 Glajchen N, Schweitzer M. MRI features in de Quervain's tenosynovitis of the wrist. Skeletal Radiol 1996; 25 (01) 63-65
• 44 Vuillemin V, Guerini H, Bard H, Morvan G. Stenosing tenosynovitis. J Ultrasound 2012; 15 (01) 20-28
• 45 Choi SJ, Ahn JH, Lee YJ. et al. De Quervain disease: US identification of anatomic variations in the first extensor compartment with an emphasis on subcompartmentalization. Radiology 2011; 260 (02) 480-486
• 46 Rettig AC. Athletic injuries of the wrist and hand: Part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 2004; 32 (01) 262-273
• 47 Sobba WD, Jacobi S, Sánchez-Navarro G. et al. Utility of patient-reported outcomes in prognosis of corticosteroid injection treatment success for trigger finger and de Quervain's stenosing tenosynovitis. Hand (N Y) 2025 April 12 (Epub ahead of print)
• 48 Oh JK, Messing S, Hyrien O, Hammert WC. Effectiveness of corticosteroid injections for treatment of de Quervain's tenosynovitis. Hand (N Y) 2017; 12 (04) 357-361
• 49 Jean Yonnet G. Intersection syndrome in a handcyclist: case report and literature review. Top Spinal Cord Inj Rehabil 2013; 19 (03) 236-243
• 50 de Lima JE, Kim HJ, Albertotti F, Resnick D. Intersection syndrome: MR imaging with anatomic comparison of the distal forearm. Skeletal Radiol 2004; 33 (11) 627-631