Description
Wrist tendonitis, or tenosynovitis, is one of the most common causes of wrist pain. This condition is primarily characterized by inflammation and irritation of one or more of the tendons surrounding the wrist joint. In a healthy wrist, as the tendons of the wrist pass over the wrist joint, they slide through sheaths that contain fluid. These tendon sheaths allow the tendons to easily glide with little friction. Wrist tendonitis develops when the tendon sheath thickens and begins to constrict the smooth gliding motions of the tendons. In most cases, wrist tendonitis develops at those points where the tendons cross one another or pass over a bony prominence.
Symptoms
- Pain over the side of the thumb or within in the wrist that travels up the forearm
- Pain may appear suddenly or gradually
- Pain worsens when the hand and thumb are being used
- Tenderness
- Limited range of motion
- Swelling
- Snapping or catching sensation when moving the thumb
Causes
- The tendon sheath becomes thickened and begins to constrict the smooth gliding motion of the tendons. The accompanying inflammation also makes the movements painful.
- Recurrent irritation of the tendon and its sheath during movement
- Repetitive movements
- Overuse
Risk Factors
- Activities that require repetitive movements
- Playing sports
- Physically demanding job
- Arthritis
- Diabetes
- Pregnancy
- Age- Middle aged women
- Wrist posture
Prevention
- Avoid activities that require repetitive wrist motions
- Avoid overuse activities
Diagnosis
- Your doctor will discuss your symptoms, review your medical history, and perform a thorough physical examination of your wrist.
- A common test to identify De Quervain’s is the Finkelstein Test: Place your thumb against your hand, make a fist with your fingers closed over your thumb, and then bend your wrist towards your little finger.
- If you have De Quervain’s, performing this test causes tendon pain on the thumb side of the wrist.
- X-ray: An x-ray may be performed to rule out a fracture.
Treatment
There are several non-surgical options for the treatment of wrist tendonitis and De Quervain’s. Early intervention is ideal as chronic cases of wrist tendonitis are more difficult to treat. If non-surgical treatments fail or the case is more severe, surgery intervention may be necessary.
Non-surgical
- Immobilization - Splinting the wrist allows the tendon to rest, therefore reducing inflammation in the area. If the thumb is affected, the thumb may be splinted as well.
- Ice - Icing will help cool the inflammation while also stimulating necessary blood flow to the afflicted area.
- Anti-Inflammatory Medication - Nonsteroidal anti-inflammatory medications (NSAIDs) help alleviate symptoms of pain, as well as decrease the swelling and inflammation of the soft tissues. NSAIDs may be taken orally or injected into the affected tendon compartment.
- Stretching to increase flexibility
- Rehabilitation exercises
- Cortisone Injections - Cortisone is a very powerful anti-inflammatory treatment option that is delivered via injection directly to the site of inflammation. These injections are considered safe, but must be limited in use since too many cortisone injections over time can actually weaken the tendons.
- Rest- Resting from activities that may irritate the area or cause pain may help alleviate symptoms on their own.
Goal
- Eliminate the patient’s symptoms such as a pain as a result of swelling and irritation.
Recovery
- The sooner treatment is started the sooner symptoms will begin to resolve and range of motion and strength will be regained.
- The duration of recovery is dependent on the severity. Symptoms may last for several weeks to months. On average, the non-operative recovery period lasts 4-6 weeks.
Benefits/Pros
- If patients find relief from non-surgical treatment methods, surgical procedures are not necessary.
Complications/Cons
- Symptoms may not completely resolve with non-surgical methods alone
- If significant tendon damage is present, non-surgical methods may not be successful
Outcomes
- Chronic cases are more difficult to manage
- Symptoms may last for several weeks to months.
- Surgery is rarely need unless the patient does not respond to non-surgical methods or there is significant tendon damage.
