Tendons are strong connective tissues in the body that connects a muscle to a bone. Wrist tendons are the ones that connect forearm muscles to the bones of the fingers and hands. Wrist tendons usually slide through sheaths with fluid as they pass by the wrist joint. These sheaths let the tendons to smoothly glide as the wrist bends in low friction. The fluid in the sheaths is called synovial fluid. When inflammation develops in this area, tenosynovitis occurs.
There are two groups of tendons that surround the wrist: the extensors and flexors. Extensors are located at the back of the wrist while flexors are those that are in front of the wrist. When tendons become irritated, they cause pain. However, tendonitis often occurs on specific tendons due to their anatomical position, and certain activities that people perform.
Causes of Wrist Tendonitis
Wrist tendonitis is caused by friction of the tendon or repetitive strain. It often occurs when there is repetitive or too much strain placed on the tendon and when tendons rub over a bony prominence. This condition is not the same with wrist sprain, which involves ligament injury (bone to bone) since tendons connect muscles to bones.
Although the term commonly used to describe this injury is tendonitis, the term tendinopathy would be a more suitable term for it since it is characterized by tendon degeneration instead of inflammation. In this condition, inflammatory cells are often absent in biopsies and other investigations. However, the symptoms and treatment of wrist tendonitis are often the same whether the injury is caused by degeneration or inflammation.
Some activities that require constant wrist movements often contribute to wrist tendonitis. These activities include playing sports such as badminton or working on a production line.
Signs of Wrist Tendonitis
Patients with wrist tendonitis often complain of pain in the wrist. Wrist tendonitis symptoms may also include:
- Redness and warmth of the tendons
- Wrist joint swelling
- Crackling or popping sounds (crepitus) with tendon movement
Wrist tendonitis is diagnosed through physical examination. Doctors may also perform tests to determine the specific source of inflammation. Special studies are often unnecessary, but X-rays can be helpful when it comes to exploring other potential causes of wrist pain. An X-ray is an imaging test that can help evaluate fractures and arthritis. Normal-looking X-rays are often seen in most people with wrist tendonitis. Other imaging tests may include an MRI or ultrasound, which can help show more details of the condition, such as fluid accumulation around the tendons.
Although most of these tests are not always required, they may help evaluate a patient’s condition if there is confusion regarding the primary cause of pain.
An effective treatment plan is prescribed once a diagnosis is confirmed. However, treatment for wrist may vary from one patient to another. Most treatment plans begin by controlling inflammation and allowing the tendon to heal. Invasive treatment may follow if the initial treatment fails to improve the symptoms.
- Immobilization: Initial treatment usually involves placing the wrist in cast or splint. Inflammation should reduce by letting the tendon rest. Wrist tendonitis often occurs when there is an overuse of the tendon.
- Icing an Injury: An ice pack can be applied at regular intervals to the inflamed area. Icing the injury can help relieve inflammation and stimulate blood circulation to the affected area.
- Taking Anti-Inflammatory Drugs: Aside from relieving pain, nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce inflammation and swelling of the tissues. These pain relievers will help lessen inflammatory responses, which are the main causes of pain.
- Hand Therapy: It is a special type of rehabilitation therapy that involves different modalities to help control and support wrist joint movements. Hand therapy is performed by physical or occupational therapists to patients who have problems with wrist and hand function, including other ligaments and tendons that support and surround the joint.
- Cortisone Shots: Corticosteroids are powerful anti-inflammatory agents that can be directly injected at the site of inflammation. Cortisone injections are proven to provide short-term relief. Long-term use is not recommended since these injections can weaken the tendons over time.
- Surgery: Surgical treatment is only recommended when other treatment options fail to relieve the condition. Surgery involves the release of tight tendon sheaths that cause painful tendon movements. Inflamed tissues can also be removed to enable the tendon to freely move as well as reduce degeneration and friction.
How can physical therapists help?
Physical therapy can be very effective for the treatment of wrist tendonitis. The treatment plan is based on the patient's condition and goal. The treatment program usually includes:
- Pain Management - The physical therapist will help you to understand and identify painful movements, and how to avoid them. To effectively reduce stress on the wrist, physical therapists will show you how you can correct abnormal postures. For a short time, you may be recommended to rest your wrist. To help alleviate the pain, you may need to apply ice. To restrict the movement of your wrist, the therapist will apply a wrist brace to speed up the healing process.
- Manual Therapy - To get the wrist properly moving, manual techniques will be used by the physical therapist. These techniques include soft tissue massages, gentle joint movements, and wrist stretches.
- Range of Motion Exercises - To help reduce stiffness and enable better movement of your wrist, forearm, and hand, you will learn exercises and stretches from a physical therapist.
- Strengthening Exercises - These exercises usually depend on the specific areas of weakness. Most of the time, an individualized home exercise will be designed by the physical therapist to properly meet the patient's specific needs. After completing a specific course of physical therapy, strengthening exercises usually follow.
- Patient Education - The physical therapist will guide you on how to perform various actions, and at the same time, how to protect your wrist and hand.
- Functional Training - As your symptoms continue to improve, the physical therapist will teach you how functional movement patterns can be correctly performed using proper wrist mechanics.
Preventing Problems in the Future
Many steps can be taken to prevent wrist tendonitis flare-ups. First, you need to modify certain activities that can worsen the condition, such as adjusting your grip or how you lift objects. Make sure that you are able to change hand positions to avoid placing too much load on a single tendon while performing certain activities.
Simple support braces or wraps during activities can be helpful instead of wearing splints. Before any activity, prepare your tendons by doing gentle stretching. The application of an ice pack can also help relieve any inflammation. However, see a doctor if the symptoms continue to persist.
- Wrist tendonitis is caused by friction of the tendon or repetitive strain.
- Although the term commonly used to describe this injury is tendonitis, the term tendinopathy would be a more suitable term for it since it is characterized by tendon degeneration instead of inflammation.
- Some activities that require constant wrist movements often contribute to wrist tendonitis. These activities include playing sports such as badminton or working on a production line.