Dorsal Wrist Carpal Boss Impingement-Dynamic Ultrasound to the Rescue!

Area of Science:

• Orthopedics
• Radiology
• Anatomy

Background:

• Carpal boss is a common anatomical variant, found in 19% of the population via cadaveric studies.
• It typically remains asymptomatic, affecting only 1% of individuals.
• Increased popularity of yoga, involving wrist hyperextension, is leading to more symptomatic cases.

Purpose of the Study:

• To highlight the increasing incidence of symptomatic carpal boss.
• To emphasize the diagnostic challenge of carpal boss on routine radiographs.
• To describe the utility of dynamic ultrasound in diagnosing symptomatic carpal boss.

Main Methods:

• Review of clinical presentations of symptomatic carpal boss.
• Description of dynamic ultrasound technique for evaluating carpal boss.
• Correlation of imaging findings with wrist hyperextension movements.

Main Results:

• Symptomatic carpal boss presents as dorsal wrist pain, often exacerbated by activities like yoga.
• Routine radiographs can be insufficient for diagnosis, requiring specialized views.
• Dynamic ultrasound clearly visualizes impingement during wrist hyperextension, confirming symptomatic carpal boss.

Conclusions:

• Carpal boss, though common, can become symptomatic due to repetitive wrist hyperextension.
• Radiologists and clinicians must consider carpal boss in cases of dorsal wrist pain.
• Dynamic ultrasound is a valuable tool for diagnosing symptomatic carpal boss, particularly during provocative maneuvers.