Painful swelling of the wrist can seriously affect your work efficiency. Wrist tendonitis is a common cause of wrist pain that prevents grandpas from lifting their adorable grandchildren. The condition is common in oldies and racket players. Hand and wrist tendinopathies have a prevalence of 4 to 56%.
De Quervain’s Tendinosis (Mommy’s Wrist)
It is a common pathology affecting the tendons in the wrist. Also known as the “mommy’s wrist”, this inflammatory condition arises when the tendon sheath that lines the wrist becomes inflamed.
Tenosynovitis syndrome is characterized by pain in the wrist and the thumb side. The rubbing of inflamed wrist tendons causes pain and discomfort. Ache is felt at the base of the thumb and wrist region as the swollen tendon moves in the narrow tunnel.
The sheath covers the muscles and tendons of the thumb and wrist. This thickening produces extra friction, causing soft tissue inflammation.
Research shows that the disease majorly affects tendons that control the movement of the thumb (abductor pollicis longus and extensor pollicis brevis).
The exact cause of the syndrome is unknown. However, racket players are at a greater risk of wrist tendinopathies. Overuse injuries and repetitive movements can also act as triggers. Direct injury to the thumb and computer usage may also be contributing factors.
Anatomy Of The Important Wrist Tendons
Tendons are fibrous cords of soft tissue that connect muscles to bones. These fibrous cords play a vital role in coordinating the movement of bones.
6 tendons in the wrist help perform different actions. The main tendons of the wrist are divided into extensors (3) and flexors (3). The tendons move through (glide) the tendon sheaths, which are fluid-filled structures.
Stages Of Tendonitis
Wrist tendonitis can be divided into 4 stages:
Stage 1 (Reactive Stage)– Discomfort is experienced at the end of movement/activity. The discomfort is worse in the mornings. This stage is characterized by thickening of the tendons.
Stage 2 (Dysrepair Stage)– Tendon breakdown during this stage causes pain on initiation of movement, which subsides on warming up.
Stage 3 (Degenerative stage)– As the name indicates, this stage is the end stage marked by degenerative changes in the tendon. There is a high risk of tendon rupture during this stage.
Signs And Symptoms
The most common symptoms of wrist tendonitis are:
Wrist Pain And Stiffness
Most patients complain of an aching wrist that gets more painful with movement. Tendinopathies of the hand and wrist are frequently associated with pain near the thumb and the pinkie fingers.
Pain is pronounced on performing activities involving the hand and wrist region. For example, certain activities like opening the door or lifting weights can trigger pain in the wrist joint.
Research shows that players diagnosed with wrist tendonitis suffer from mild to moderate wrist pain during the game. Pain intensity varies with the stages of tendonitis.
Model-based analysis has revealed that joint stiffness is present in musculoskeletal disorders like tendonitis. Some patients complain of stiffness when moving the wrist.
Crepitus (Creaking Noise) And Snapping
Another important feature of wrist tendonitis is the production of “popping/catching sounds” when moving the hand and wrist. Patients feel something cracking in their fingers and wrists. Patients with hand and wrist tendinopathies hear this popping sound, i.e., crepitus.
Sometimes patients also experience a snapping sensation in the thumb. A 73-year-old female suffering from de Quervain disease experienced a snapping sensation in her thumb. Ultrasound-guided imaging revealed swollen wrist tendons to be the cause of the symptom.
Reduced Range Of Motion And Wrist Weakness
Prolonged inflammation of the wrist tendons ultimately leads to muscle weakness. Pain and swelling greatly reduce the range of motion of the wrist joint. In addition to reduced mobility, patients also suffer from muscle weakness.
You may feel incapacitated to do simple activities that involve hand and wrist muscles. Using a computer (typing, handling a computer mouse, using a game controller), gripping and throwing become uphill tasks.
Other symptoms of wrist tendonitis include warmth, redness and swelling of the wrist joint. The inflamed tendons appear red and are warm due to increased inflammatory cells in the region.
Causes And Risk Factors
Tendon inflammation is mostly an overuse injury. Individuals involved in strenuous hand/wrist movements are at a greater risk of developing tenosynovitis. Playing sports like tennis, ping-pong, and badminton makes you prone to wrist tendinopathies.
According to a study, badminton players are prone to developing wrist tendonitis. The study highlighted a link between the physical activity of sub-elite badminton players and the occurrence of wrist tendonitis.
Another major cause of the disease is repetitive motion of the hand and wrist. Music instrument players (violinists, keyboard players) carry out repetitive wrist movements. Poor hand mechanics also contribute to the development of tendinopathies of the hand and wrist.
Sudden tendon injuries to the tendons can also trigger soft tissue inflammation. In the event of injury/trauma, wrist tendonitis can be accompanied by elbow tendonitis (lateral epicondylitis.
Comorbidities And Infections
Different underlying chronic conditions put you a step closer to wrist tendonitis and tenosynovitis. Diabetics and arthritis patients have increased breakage of soft tissues and higher chances of inflammation.
Osteoarthritis, rheumatoid arthritis, and gouty arthritis patients can suffer from swelling of the tendons. These chronic pain disorders put you a step closer to developing wrist tendonitis.
How Is Wrist Tendonitis Diagnosed?
The diagnosis of wrist tendonitis depends upon multiple aspects, including the history of symptoms, physical examination and radiographs of wrists and fingers.
After a complete medical history, the doctor performs a physical exam. During the examination, your doctor will palpate the bones and check for signs of swelling and tenderness.
You will also be demanded to perform certain movements by your healthcare provider. These movements fall under the Finkelstein test used to diagnose de Quervain’s syndrome. Most patients are asked to bend the thumb into the palm and make a fist or bend the wrist towards the pinky. The diagnosis is tenosynovitis if the wrist’s thumb side is painful on motion.
Imaging the wrist joint is crucial in getting wrist tendonitis diagnosed.
X-rays– are done to rule out fractures and bone anomalies.
MRI scans- provide a better picture of the joint soft tissues.
Ultrasounds- aid in imaging the fluid accumulation within the tendons.
There are multiple conditions similar to wrist tendonitis that should be ruled out. Wrist tendonitis DD includes Carpal Tunnel Syndrome, arthritis, trigger finger and fractures.
Treatment Of Wrist Tendonitis
Conservative treatment strategy is the first line of treatment. You can follow some simple steps to manage the painful condition:
Inadequate rest can increase pain and inflammation and can result in aggravated tendon pain. Repetitive motions of the inflamed structures can delay the healing process as well. Thus, taking adequate rest is an ultimate part of treatment.
Ice pack application (I)
Applying ice on the inflamed soft tissues removes the inflammatory cells faster. The faster the swelling reduction, the better the pain relief. The main aim of symptomatic management is to reduce pain.
Slight compression of the wrist joint allows you drainage of the accumulated fluid in the synovial lining and tendons.
Keeping the hand and wrist elevated while resting promotes gravity-assisted drainage of excess fluids in the sheath.
Immobilization With Splints And Braces
The best way to treat wrist tendonitis is to get a custom splint for your hand/wrist. This particular type of treatment supports the structures, takes the pressure off the joints and prevents further injury. The wrist heals on its own, a custom splint is just to ensure that it heals uneventfully.
Medications And Steroid Injections
Your healthcare provider will prescribe nonsteroidal anti-inflammatory drugs (acetaminophen, ibuprofen, etc.) to reduce inflammation. Oral steroids and non-steroidal anti-inflammatory medication can play an important role in alleviating pain and swelling. You should follow the prescription until the discomfort subsides.
Patients seeking immediate relief can go for a corticosteroid injection into the joint. This effectively removes inflammation from the wrist region.
Physical Therapy/Occupational Therapy
Physical therapy is the most effective treatment modality for wrist tendonitis. Hand therapy from a physical therapist alleviates pain and improves blood flow to the damaged tissue. This helps reduce swelling and improves the range of motion.
Many businesses and offices now provide occupational therapy to prevent tendonitis in computer workers. Individuals who use computers at work must take regular breaks to allow the release of pressure from the wrists and hands.
Physiotherapists not only ease pain but also teach you the right mechanics of lifting heavy items and preventing injury in the future.
Ultrasound-guided needle therapy is a minimally invasive procedure done to remove damaged tendons (that can not repair). It has been shown to be an efficacious procedure. This very procedure has shown promising results in conservatively managing hand and wrist pathologies (managing nerve damage caused by CTS).
Orthopaedic surgeons prefer managing wrist tendonitis conservatively, and surgery is reserved only when non-surgical treatments fail. Tendon release surgery is the treatment of choice to relieve pain from tendon sheath swelling.
In case of extensive damage, the procedure is performed under general anaesthesia. Your orthopaedic surgeon will make a small incision to access the wrist structures. Through this small hole, the surgeon cuts away the inflamed tissues.
Surgery is the last resort reserved for severe cases only. It provides relief, but there are multiple risk factors involved in surgery.
Wrist tendons have a poor blood supply, which is why they struggle to heal properly on their own. Prolotherapy involves the injection of a regenerative solution into the tendon to provide a direct supply of what is needed to heal the tendon and provide pain relief.
As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.
Frequently Asked Questions
How long does it take wrist tendonitis to heal?
Wrist tendonitis is a self-limiting condition but can take some time to heal. Mild wrist pain can easily be managed with domestic interventions like RICE and splinting. On average, a mild case of wrist tendonitis takes about six weeks to heal.
What does tendonitis feel like in your wrist?
Patients experience wrist pain on lifting and gripping objects. The intensity of pain varies from case to case. Opening doors (knobs) and lifting even small weights triggers pain. Some patients report having a snapping sensation in the wrists. The range of motion is reduced and over time, muscle weakness develops.
How do you treat tendonitis in the wrist?
The vast majority of cases respond well to home therapies and medications. Patients are advised to take adequate rest and apply ice on the inflamed portion. Wearing a wrist splint prevents further injury and promotes healing. NSAIDs and steroids are advised for symptomatic management of tendonitis.
What are the 4 symptoms of tendonitis?
The 4 symptoms of tendonitis common to all types are:
Pain that exacerbates on movement.
Swelling of the tendons, which presents as redness and warmth on the skin.
Reduced mobility and difficulty in moving the particular joint.
Cracking and snapping sensation in the joint.
What aggravates wrist tendonitis?
Poor arm and wrist mechanics while working aggravate tendonitis. Overusing the joint or having inadequate rest after irritation of the tendons can aggravate tendon inflammation. Multiple comorbidities like rheumatoid arthritis, diabetes, osteoarthritis and gout can also contribute to aggravation.
What is Stage 1 tendinitis?
Based on the initiation of pain, tendinitis can be divided into 4 stages. Stage 1 tendinitis is characterized by pain that is felt at the end of the activity. As it is common in players, wrist pain is only felt after the game ends.