Wrist Hand Tendonitis Treatment
Tendons are tough pieces of connective tissue that attach muscles to bones. Tendons lie within sheaths of tissue lined with synovium- the same tissue that lines joints.
The term “tendonitis” refers to inflammation of the tendon sheath. Tendonitis occurs when a tendon becomes inflamed from overuse activities.
The wrist is a highly mobile joint consisting of the distal radius and ulna, eight wrist bones, and the base of all five fingers. Because of the highly mobile nature of the joint, the muscles and tendons that perform these movements can become inflamed.
Tendonitis at the wrist is most often caused by repetitive use. In fact, it is considered a “repetitive stress injury”. Activities that predispose to wrist tendonitis include throwing, catching, bowling, hitting a tennis ball, typing, or sewing.
In addition to repetitive motion, certain types of arthritis such as rheumatoid arthritis, psoriatic arthritis, gout, and pseudogout can also cause tendonitis in the hand and wrist.
Symptoms include pain, swelling, tenderness, and sometimes redness. The tendons in the wrist are divided into different compartments including the extensor compartment (allow the wrist to point the hand up), the flexor compartment (allow the wrist to point the hand down), the radial compartment (allow the wrist to point the hand toward the thumb), and the ulnar compartment (allow the wrist to point the hand towards the pinky).
Tendonitis can affect the flexor, extensor, radial, and ulnar compartments.
One very common form of tendonitis involving the wrist is DeQuervain’s tenosynovitis. This affects the extensor tendon sheath of the thumb. On exam, a physician will sometimes perform the Finkelstein’s maneuver. The thumb is placed across the palm and the fingers are close over the thumb. The examiner then forces the hand to the ulnar side of the wrist (towards the pinky). This reproduces the pain.
Finger tendonitis often manifests itself as a trigger finger. This is a situation where the finger will lock or stick when it is bent or straightened. This can be very painful, particularly if the finger sticks and the patient has to forcibly straighten the finger.
Treatment of wrist and hand tendonitis consists of rest, elevation, and ice applied to the affected region for 20 to 30 minutes every 4 hours for 3 days. Anti-inflammatory medication or topical rubs may be helpful. Occasionally, wearing a splint or cast on the wrist and or thumb may be suggested.
Steroid injection is often used as well.
In patients who have chronic or refractory tendonitis, percutaneous needle tenotomy using ultrasound guidance along with autologous tissue grafting is often curative. This procedure is performed using local anesthetic and a small gauge needle to irritate the tendon. The tissue graft, which consists of platelet rich plasma, leads to healing of the tendon. This procedure often prevents the need for surgery.
Surgery is the final option.