Wrist Tendonitis Signs, Causes, and Treatments

Wrist tendonitis, also called tenosynovitis, is a common condition characterized by irritation and inflammation of the tendons around the wrist joint. Many tendons surround the wrist joint. Wrist tendonitis usually affects one of the tendons, but it may also involve two or more.

Often, wrist tendonitis occurs at points where the tendons cross each other or pass over a bony prominence. These are possible sites of irritation and can lead to discomfort when moving the wrist joint.

Tendons are structures that connect a muscle to bone, and the wrist tendons connect the forearm muscles to the bones of the hand and fingers. The wrist tendons slide through smooth sheaths as they pass by the wrist joint. These tendon sheaths allow the tendons to glide smoothly as the wrist bends back and forth in a low-friction manner. The tendon sheaths have fluid within the sheath called synovial fluid, and when this area becomes inflamed, the condition is called tenosynovitis.

The tendons surrounding the wrist are divided into two groups: those of the back of the wrist (the extensors) and those on the front of the wrist (flexors). Any tendon can become irritated and cause symptoms of pain, but tendonitis occurs much more commonly in a few specific tendons as a result of the anatomy, and the specific activities people perform.

The problems that can occur to the wrist tendons can vary depending on the specific condition. Some conditions are characterized more by inflammation, where others are characterized more by chronic damage to the tendon (tendinosis). Sometimes systemic conditions such as gout or pseudogout can be involved, and in other situations, autoimmune conditions including rheumatoid arthritis might contribute to the symptoms.

The most common and consistent complaint of patients diagnosed with wrist tendonitis is a pain in the wrist. Other symptoms of wrist tendonitis include:

• Swelling around the wrist joint
• Warmth and redness of the tendons
• Grinding sensations (crepitus) with the movement of the tendons

The diagnosis of wrist tendonitis is made by looking for the characteristic signs of this condition. In addition, depending on the tendon that is inflamed, the physician may perform tests that stretch the specific tendons of concern to locate the precise source of inflammation.

For example, one type of wrist tendonitis is called DeQuervain's tenosynovitis. This is inflammation of the tendon at the base of the thumb. Often seen in new mothers, DeQuervain's tenosynovitis is diagnosed by a specific test called "Finkelstein's test," where the patient makes a fist and the wrist is pulled away from the thumb. Pain from this maneuver is diagnostic of this type of wrist tendonitis.

Special studies are typically not necessary, but an X-ray can be helpful to evaluate for other possible causes of wrist pain. X-rays can be particularly helpful at evaluating for arthritis or fractures. Most people with wrist tendonitis will have normal appearing X-rays. Other tests such as ultrasound and MRI can show tendonitis more directly, as these test will show fluid accumulation around the aggravated tendon. While these tests are not typically necessary, if there is confusion about the possible cause of pain, they may be helpful to further evaluate the problem.

Once a diagnosis of tendonitis has been made, a treatment plan can be developed. Not every person who has wrist tendonitis will be treated the same, and some treatments may be more helpful for a particular type of tendonitis than others. That said, most treatments start off with a few simple steps to control inflammation and allow tendon healing, and only proceed to more invasive steps if these treatments fail to alleviate the symptoms of the condition.

• Immobilization: Placing the wrist in a splint or a cast is usually the first treatment step. Wrist tendonitis is due to recurrent irritation of the tendon and its sheath. By resting the tendon, the inflammation should decrease.
• Ice the Injury: Applying an ice pack intermittently to the area of inflammation may also be beneficial. Icing wrist tendonitis can help to cool inflammation and stimulates blood flow to the area of tendonitis.
• Anti-Inflammatory Medications: Nonsteroidal anti-inflammatory medications will help control symptoms of pain, but more importantly they help treat wrist tendonitis to decrease inflammation and swelling of the soft tissues. These treatment medications will decrease the inflammatory response, which is the cause of the pain.
• Hand Therapy: Hand therapy is a specialized type of therapy that is focused on the complex function of the hand and wrist, and the many tendons and ligaments that surround and support the joint. Hand therapists use many modalities from stretching and strengthening to electrical stimulation and ultrasound. In addition, a hand therapist will often fabricate custom splints and supports to help control movements of the wrist joint.
• Cortisone Injection: Cortisone is a more powerful anti-inflammatory treatment option that is given by injection directly to the site of inflammation. Cortisone injections are safe but can weaken tendons over time if too many injections are given.
• Surgery: Surgery is only done when these other treatment methods have failed to solve the problem. If that is the case, the area of tight tendon sheath that causes the painful and difficult tendon movements can be released. The inflammatory tissue can also be removed in an effort to create more space for the tendon to move freely.

There are a number of steps that you can take to prevent flare-ups of wrist tendonitis. The most important step you can take is to modify any specific activity that seems to aggravate your condition. This may mean adjusting the way you lift or adjusting your grip. Changing the position of your hands when you perform activities can ensure no single tendon takes too much of the load.

• Wearing a splint during activities that irritate your tendonitis can be helpful, but this may also be cumbersome. Certainly, a simple support wrap or brace can be an easy way to avoid symptoms.
• Use caution taking medications before activities, as sometimes this can simply cover up symptoms, when it may be better for you to be able to assess when you are overdoing an activity.
• Gentle stretching and heat before an activity can ensure the tendons are ready, and an ice pack afterward can quiet any inflammation.

If you can't keep control of the symptoms, it might be time to see your doctor.

Wrist tendonitis is a common condition that will be experienced by almost everyone at some point in your life. Taking a few simple steps early on in the condition can help prevent the symptoms from becoming more severe and disabling.

If you have problems with wrist tendonitis, working with a hand therapy specialist to develop a program to prevent recurrent problems can help keep you doing the activities you either need to do for work or enjoy doing recreationally!