Snapping wrist due to bony prominence and tenosynovitis of the first extensor compartment: A case report

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 6 th 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.