The thick and fibrous cords that connect muscles to bone are called tendons. A human body contains roughly about 4000 tendons, depending on the person’s size.
Whenever the suffix “itis” is added to a medical term, it means inflammation of that structure. Therefore, “Wrist Tendonitis” is nothing but inflammation of your wrist’s tendons due to any injury or repeated motion. Statistics show that Snowboarders are most prone to such wrist injuries.
In this write-up, I will talk about the causes, symptoms, prevention, and various treatment modalities of wrist tendonitis. But before I start with the inflammatory story of an injured tendon, let’s understand its anatomy.
Anatomy of Wrist Tendons
As discussed above, tendons are cords connecting muscles to the bones. The wrist tendons connect the muscles of our forearm to the bones of our hands and fingers.
When these wrist tendons pass through the wrist joint, they slide over them smoothly as tendons are enclosed in protective synovial sheaths. These tendon sheaths contain synovial fluid within the sheaths. Due to the presence of this lubricating fluid, the tendons glide whenever we move our wrists back and forth.
Inflammation of the tendon and its sheath is called tenosynovitis.
The tendons around the wrists are divided into the following two groups:
- Extensors – those present at the back of the wrists
- Flexors – those present at the front of the wrists
What Is Wrist Tendonitis?
A simple definition of wrist tendonitis would be “inflammation of the tendons surrounding the wrist.” As stated above, when the sheath is inflamed, it is known as tenosynovitis. Both the tendon and sheath can be inflamed at the same time.
Usually, the irritation and inflammation of the wrist tendons occur where the tendons cross each other over a bony prominence (any place where the bone is close to the human body’s surface). That ultimately leads to pain and discomfort while moving the affected joint.
What Are the Causes of Wrist Tendonitis?
The causes of wrist tendonitis may vary considerably depending on the specific conditions of the patient. It can be caused by inflammation, injury, or chronic damage.
Repeated movements of the wrist most commonly cause tendonitis such as:-
- Using the computer for long hours
- Playing video games works that require repetitive movements such as chopping, wood hammering, etc.
- Physical work involving wrist movement
- Sports such as tennis and badminton
Some of the other factors that also contribute to the risk of tendonitis are-
- Poor wrist posture
- Any acute injury from a sudden blow or impact
- Poor alignment of joints
An important point to note is not to confuse tendonitis with wrist arthritis or Carpal tunnel syndrome. One condition can aggravate another, but still, they all are different entities.
- Wrist Tendonitis is an inflammation of the wrist tendons.
- Wrist Arthritis is an inflammation of the wrist joints.
- Carpal Tunnel Syndrome is due to the compression of a nerve.
The first symptom that you observe when you wake up in the morning is pain and stiffness in your affected wrist. The affected wrist feels sore and tender on the touch.
You can also probably see some mild swelling.
Let’s go through the most common symptoms and then proceed to the less common ones.
The most common symptoms of wrist tendonitis are:
- Pain that is dull but can worsen with movements
- Joint stiffness
The other less common symptoms seen include:
- A grinding sound or creaking when you move your wrist
- Weakness in the wrist
The inflammation in your wrist can limit your hand motion. You experience weakness while performing simple routine motions such as typing, pinching, gripping, using a laptop or mouse, playing video games, texting, etc.
Types of Wrist Tendonitis
Wrist tendonitis is classified based on the type of tendons affected:
Extension Wrist Tendonitis
This condition develops when you constantly bend your wrists backward. Some of the examples of extension wrist tendonitis are:
- Intersection Syndrome: A condition in which a group of four tendons present in the wrist is inflamed.
- Extensor Carpi Ulnaris Tendonitis: Inflammation in the muscle that connects the outer side of your forearm to the fifth metacarpal bone of your hand (it helps to move the wrist towards your pinky finger
Flexion Wrist Tendonitis
This condition develops due to repeated forward bending of the wrist or Flexor carpi radialis tendonitis.
The most common types of hands and wrist tendonitis are:
- De Quervain’s Tenosynovitis: This disorder results in pain and swelling in the tendon sheath present in the thumb’s tendons.
- Trigger thumb or finger: a form of tenosynovitis where the tension sheath tendon sheet is inflamed, making it resistant to bending or straightening the finger or thumb.
- Flexor carpi radialis tendonitis.
Various factors can put a person at risk for wrist tendonitis:
- Professional: Repeated movements during sports, household chores
- Age-Related: with increasing age, the tendons become stiff with irregular tissue formation and decrease the wrist tendon’s ability to hold weights by a whopping 50%
- Medical Conditions: Diabetes, high cholesterol, increased uric acid (progressing to gout), or obesity. Effects of Ageing on Hand Function
- Genetics: A subtype of wrist tendonitis, hypermobility type, is significantly associated with tendonitis. E.g., Ehler – Danlos Syndrome.
- Medicines: NSAIDs and corticosteroids in the form of tablets or injections can reduce an injured tendon’s healing process. It may weaken the tendon if these medications are consumed frequently or taken for long periods, i.e., more than 14 days
Why Are the Tendons of the Wrists More Prone to Tendonitis?
Many reasons make the tendon surrounding the wrist more prone to injury such as sports, repetitive movements while doing work and accidents. Some of the contributing factors making wrist tendons more prone to tendonitis are listed below:
- Blood Vessels
Tendons have less blood supply than the muscles; therefore, if you perform any repeated movements such as playing longer sports, video games, or riding a bike, the tendon’s blood supply is drastically reduced. The reduced blood supply to the tendons of your wrist continuously can result in wrist tendonitis.
The small wrist tendons contain numerous nerve fibers involved in fine movements; hence, these tendons transmit more pain signals to the brain when affected compared to the larger ones.
When you continuously move your wrists, there is a 10% increase in the tendon’s internal temperature. Hence, temperature also plays a critical role in causing wrist tendonitis.
When to Seek Medical Attention?
If you have one or more of the above discussed potential risk factors, consider seeking medical advice.
Suppose you suspect any pain, discomfort, swelling, immobility, severe ongoing swelling, resistance to movement, or any tingling sensation in the fingers. In that case, these symptoms can indicate any bone fractures or nerve damage in your wrist.
In some cases, it can even progress and irritate an adjacent nerve causing carpal tunnel syndrome.
A professional can perform some specialized clinical tests to determine the inflamed wrist tendon’s location and severity.
The following are the clinical tests performed to evaluate the function and stability of the wrist tendons:
- Wrist Extensor Tendonitis Test
Evaluates the inflammation in the extensor tendons of the wrist joint and includes:
- Wrist Flexion Tendonitis Tests
Evaluates the inflammation in the wrist joint’s flexor tendons and include tests for flexor carpi ulnaris tendon and Flexor carpi radialis.
- Finkelstein test
Evaluate the presence of De Quervain’s disease
How Can I Prevent Wrist Tendonitis?
If you do not want to go through the excruciating pain and discomfort, then keep a note of the following points:
- Avoid long hours of wrist movement like texting, household chores, writing, etc. Instead, take small breaks.
- Before and after you use your wrist or hand, stretch them to maintain flexibility and warm up the muscles.
- Infuse some joint protection methods in your daily routine.
- Stop the activity as soon as you feel pain or any discomfort in the wrist or hand.
- Regular follow-up with your health care professional if you have any systemic disease like arthritis, gout, etc.
Treatment of Wrist Tendonitis
In most cases, wrist tendonitis is successfully treated with non-surgical methods.
Usually, it takes around a few days or weeks to heal the tendonitis. However, when left untreated, it may become chronic and extend up to many months. Let’s first take a look at the non-surgical treatment modalities.
The first and foremost step to treat wrist tendonitis is to immobilize the wrist by either using splints, slings, straps or even a cast. Avoid using the wrist for long hours.
Incorporating small movements with intermittent rest can speed up the healing process.
Intermittent application of an ice pack on the affected wrist can tone down the inflammation and improve the blood flow to the wrist tendons.
Instead of using heavy loads, try exercising with lighter loads and increasing the number of repetitions.
Eccentric exercises are proven to be beneficial for tendon healing. These types of exercises increase collagen production and decrease the temperature of the tendon.
There is a specialized therapy called hand therapy entirely focused on improving wrist function and stability. This therapy includes stretching and strengthening exercises, electric stimulation, and ultrasound.
These kinds of therapies are done under the guidance of occupational or physical therapists.
The use of drugs to treat wrist tendonitis has always been controversial.
However, NSAIDs and steroids are used to relieve tendonitis pain and also to reduce inflammation and swelling.
On the other hand, some scientists believe that these drugs may delay tendons’ healing, ultimately worsening wrist tendonitis.
Cortisone injections are directly administered at the inflamed site. On the contrary, too many cortisone injections may weaken the tendons.
It’s important to note that these medications can have adverse effects on the stomach, kidneys, and heart when taken for the long term. Thus, doctors recommend not taking these drugs for more than 14 days.
Platelet-Rich Plasma Injection
In this method, the patient’s blood is drawn, concentrated, and administered again to the patient with an injection. The number of injections administered can vary depending on the severity of the tendonitis.
It contains growth factors stimulating the growth and healing of the tendons.
Extracorporeal Shockwave Therapy
In extracorporeal shockwave therapy, a series of shock waves are administered into the injured tendons that relieve the pain by preventing new nerves’ formation in the tendons.
A series of high and low energy shock waves are used in the therapy. Numb the area with the help of Local Anesthesia before administering the shock waves.
Depending upon the severity, one or more cycles of electric shock waves are administered to treat wrist tendonitis.
- When non-surgical treatment modalities fail to treat the wrist tendonitis
- Chronically degenerated wrist tendons (tendinosis)
- When the wrist tendonitis progresses more than the 3-6 months
The inflamed tissues are surgically removed to create more space for the wrist tendons to move freely.
Minimally Invasive Therapy
Needles and small tubes are used in the minimally invasive therapy. This therapy includes:
- Arthroscopic surgery
A large incision is made on the skin overlying the affected wrist tendon. The various open surgical methods performed are-
- Tendon sheath release
- Tendon grafting
- Tendon transfer
- Tendon repair surgery
- Scar tissue formation
- Stiffness in the wrist
- Nerve damage
About 95% of the surgeries heal without any complications. Healing of the wrist tendonitis usually takes three to four weeks.
Most of us are going to experience wrist tendonitis at least once in our life. Try to prevent this by following some easy, simple tips. Consult a physician when you suspect any swelling in your wrists.
Let us know what you liked about this article in the comments section and share it with your friends and family who might need some quick tips to resolve their wrist tendonitis.
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.