Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2021; 9(16): 3908-3913
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.3908
Snapping wrist due to bony prominence and tenosynovitis of the first extensor compartment: A case report
Chia Jung Hu, Po-Chin Chow, I-Shiang Tzeng
Chia Jung Hu, Po-Chin Chow, Department of Orthopedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
I-Shiang Tzeng, Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
Author contributions: Hu CJ treated the patient and wrote the manuscript; Chow PC helped to perform dynamic sonography; Tzeng IS assisted the revision and submission of the manuscript.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chia Jung Hu, MD, Occupational Physician, Department of Orthopedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289 Jianguo Road, Xindian District, New Taipei 23142, Taiwan. evacrazer@gmail.com
Received: August 4, 2020
Peer-review started: August 4, 2020
First decision: December 14, 2020
Revised: January 13, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: June 6, 2021
Abstract
BACKGROUND

A snapping wrist is a rare symptom that results from the sudden impingement of one anatomic structure against another, subsequently causing a sudden movement only during wrist movement.

CASE SUMMARY

A 30-year-old woman with a history of right wrist contusion reported right wrist snapping after overuse. The snapping became symptomatic after moving heavy objects. The pain persisted even when she received 1 mo of conservative treatment. Physical examination showed painful wrist snapping during wrist radioulnar motion and thumb abduction-adduction. Radiography demonstrated bone overgrowth over the radial styloid process. Sonography disclosed a tendon jumping over a bony prominence in the first compartment during wrist motion. Magnetic resonance imaging revealed no anomalous tendon nor tumorlike lesion. Under the wide-awake local anesthesia no tourniquet (WALANT) technique, the lesion was identified in the first extensor compartment. The patient received stepwise extensor retinaculum release, synovectomy, and bone spur removal. By 6th week, the patient was completely free of pain and unable to snap her wrist. She started working 7 wk after the surgery. One year after the surgery, the wrist snap was not recurrent.

CONCLUSION

Careful physical examination and dynamic sonography may confirm the diagnosis of a snapping wrist. With the WALANT technique, the lesion could be identified under direct vision, and we could take stepwise interventions according to intraoperative presentations.

Keywords: Snapping wrist, Tenosynovitis, Wide-awake local anesthesia no tourniquet technique, Orthopedics, Snapping syndromes, Wrist, Case report

Core Tip: Wrist snapping is a rare symptom in clinical scenario. We reported a young lady with asymptomatic wrist snapping that became painful after long term overuse. This study offered dynamic sonographic images and intraoperative pictures to identify the pathogen of the snapping wrist, which was not reported by previous research. Besides, we presented stepwise interventions in the surgery and showed the advantage of the wide-awake local anesthesia no tourniquet technique in treating our patient.