The etiology of dorsal wrist pain associated with loading of the wrist in extension has not been clearly identified in the literature. Many exercise disciplines incorporate upper extremity weight-bearing exercises in an extended wrist posture, for example push-ups, plank position, and various yoga and Pilates poses. This study evaluates patients with dorsal wrist pain in the extended wrist-loading position and identifies anatomic abnormalities in the wrist using magnetic resonance imaging (MRI). A retrospective chart review was performed comparing MRI of patients who complained of dorsal wrist pain while performing weight bearing in a wrist extension position with a control group of patients who complained of ulnar-sided wrist pain. The primary MRI outcome was dorsal wrist pathology, including occult dorsal ganglion cyst, scapholunate ligament tear or degeneration, and dorsal capsulitis. Dorsal wrist pathology was significantly more prevalent in patients with dorsal wrist pain (84%) than in the patient cohort with ulnar-sided wrist pain (12%). Occult dorsal ganglion cysts were the most common sources of pathology (76%). MRI demonstrated an identifiable dorsal abnormality in 84% of patients with dorsal wrist pain associated with weight bearing on the extended wrist. Occult dorsal ganglion cysts are the most common cause of dorsal wrist pain, followed by partial scapholunate tears. When patients complain of dorsal wrist pain during specific extended loading wrist positions such as push-ups, yoga, or Pilates poses, an MRI may be warranted to help identify anatomic abnormalities that may help guide treatment choices. Diagnostic, Level III.

The proximal tibiofibular joint (PTFJ) is susceptible to osteoarthritis (OA), making it a rare but potential source of lateral knee pain. Because PTFJ OA is a rare presentation of knee pain, no first-line treatment has been established and it can be missed in evaluation before total knee arthroplasty. We report an unusual case of a 59-year-old man who presented with advanced OA of both the knee and PTFJ, along with a progressive peroneal nerve palsy due to a large compressive ganglion cyst from the PTFJ. He was treated with concurrent total knee arthroplasty, peroneal nerve decompression, and resection of the fibular head and ganglion cyst, resulting in full recovery from his arthritic pain and resolution of his peroneal neuropathy. He remains free of symptoms without instability 3 years from the index surgery.