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Scaphoid Impaction Syndrome

- See: Differential Diagnosis of Dorsal Wrist Pain

- Discussion:
    - scaphoid impaction syndrome occurs usually as result of repetitive hyperextension stresses such as occur in floor exercises of gymnasts,
          when weight lifters rest the weight bar on their palms, or from excessive push-ups;
    - occasionally single forceful injury will suffice;
    - symptoms are pain, weakness, and tenderness at dorsoradial aspect of wrist usually aggravated by extension;
    - point tenderness over dorsal scaphoid rim is elicited w/ wrist in modest flexion and ulnar deviation;
    - x-rays occasionally show small ossicle contiguous w/ scaphoid rim on lateral views in slight flexion;
    - in chronic cases, the scaphoid rim shows hypertrophic ridge that may be of sufficient height to impair extension;

- Diff Dx:
    - radial styloid impingement syndrome:
         - similar to the scaphoid impingement except that symptoms are usually noted in the anatomic snuff box and are produced by radial 
              deviation with pressure exerted on scaphoid tuberosity from the radial styloid;
         - tenderness is elicited from palmar aspect of radial styloid or pain from forced radial deviation;

- Treatment:
    - when all other possible causes of the wrist pain have been excluded and when the patient has failed conservative treatment, then radial 
           cheilectomy of the dorsal scaphoid ridge (or the dorsal radial lip) is the treatment of choice

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