Hand and Wrist

Hand and Wrist Tendinitis

Anatomy

Tendons are rope- or cord-like bands of tissue that connect muscle to bone. When a muscle contracts, the tendon pulls on the bone it is connected to, causing that body part to move. Many tendons in the hand and wrist pass through tunnels (tendon sheaths) that keep them organized and held snugly in place, positioned close to the bone. These tendons are covered in a slippery thin layer of soft tissue (synovium) that enables them to pass through the tunnels easily.

Description

Tendinitis occurs when a tendon becomes irritated, inflamed or swollen and causes the synovium around the tendon to swell, changing the shape of the tendon sheath compartment and making it difficult for the tendons to move properly. Tendinitis can cause pain and tenderness along the hand or wrist that is particularly noticeable when grasping or gripping, forming a fist, or turning the wrist. Pain in the thumb-side of the wrist is the primary symptom of De Quervain's tendinitis, one of the most common types of wrist tendinitis. Other types of tendinitis in the hand and wrist include tendinitis of the wrist flexor and extensor tendons, intersection syndrome, and trigger finger or trigger thumb.

Symptoms

Pain may appear gradually or suddenly, and travel to other regions of the hand, wrist or forearm. A catching or snapping sensation may be experienced when moving the hand, wrist or fingers. Movement of these areas may be difficult due to pain and swelling, which can also cause weakness in the hand. Although swelling in a tendon is not always obvious, it is noticeable with some forms of hand and wrist tendinitis. In some cases, numbness may also result from irritation of nerves lying on top of the tendon sheath. Tenderness directly over the tendons in the affected area is common in certain types of tendinitis, and can be quite painful.

Causes

Overuse is a common contributor to hand and wrist tendinitis. It can also be associated with pregnancy and inflammatory arthritis, such as rheumatoid disease, which can occur in the hand or wrist.

Diagnosis

Your physician may perform a variety of specialized tests to determine if you have tendinitis, and if so, from what tendon.

Nonsurgical Treatment

Simply avoiding activities that cause pain and swelling may be enough to allow symptoms to abate on their own, without additional treatment. Although most tendinitis pain will eventually improve on its own, it may require many months to resolve.

Nonsurgical treatment options to relieve pain caused by irritation and swelling include:

• Ice and heat—Ice and heat therapeutic modalities may be carefully applied to help provide relief from symptoms.
• Splints—Your orthopaedic surgeon may prescribe use of a splint to provide support and allow rest for the thumb and wrist during recovery.
• Nonsteroidal anti-inflammatory medication (NSAIDs)—Drugs such as ibuprofen or naproxen may help relieve pain, inflammation and swelling. Most people are familiar with nonprescription NSAIDs such as aspirin and ibuprofen, however, whether using over-the-counter or prescription strength, they must be used carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Corticosteroids—Steroids are powerful anti-inflammatories that can help decrease pain and inflammation. These may be prescribed by your orthopaedic surgeon to be taken orally, or as an injection into the tendon sheath. Many patients experience short-term relief from these injections, however they typically do not provide a cure. Discuss the risks and benefits with your physician.

Surgery

If symptoms are severe or do not improve with nonsurgical treatments, surgery may be needed to open the tendon sheath compartment and make more room for the inflamed tendons. Following surgery, use of the hand is typically resumed once comfort and strength have stabilized.

With any surgery, there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.