Wrist Tendonitis

Tendonitis is swelling or inflammation of the tendon or tendon lining called tenosynovium. Tendons at the wrist are normally confined to tunnels they travel through. With swelling, the tendon gets trapped and won’t glide well. Technically any tendon can suffer tendonitis, but the most common tendonitis occuring in the wrist is called Dequervain’s disease, which invlolve the tendons on the thumb side of the wrist(tendons of the first dorsal compartment) that straighten the thumb. Other sites of frequent tendonitis is the Flexor Carpi Radialis(FCR) tendon that is a tendon on the palmar side of the wrist which bends the wrist towards the palm and thumb side. The FCR tendon travel in an independent compartment within the carpal canal. The Extensor Carpi Ulnaris tendon travels at the sixth dorsal compartment on the back of wrist and can also suffer tendonitis. The tendons of the first dorsal compartment and the second dorsal compartment cross paths at the distal forearm, just proximal to the extensor retinaculum pulley mechanism which can on occasion also cause mechanical irritation resulting in a teondonitis of the second compartment called Intersection Syndrome. In general tendonitis can be caused by overuse, pregnancy or inflammatory conditions such as rheumatoid arthritis. Repetitive motions during grasping or pinching can predispose to a tendonitis. Symptoms of tendonitis include mechanical pain, swelling, tenderness, an associated lump or thickening of the tendon with an occasional ganglion cyst is present on the tendon or extensor compartment.

Treatment is focused on prevention to those individuals at risk who are involved in certain professions. Prevention includes changing the work station environment, education about body posture and positions during activities at work, use of ergonomic assisted tools, breaks during heavy repetitive tasks for stretching and to rest the extremities and limit fatigue that can instill a risk of error and progressively deteriorate body posture. From an anatomic approach, or goal is to make the space around the tendons bigger, or make the contents of the space smaller. Treatment always begins by breaking the vicious cycle of swelling and friction with ergonomic changes and education, splinting, and the use of acortisone injection between the tendon and its pulley, helping to shrink the size of the tendons and tendon lining in the tendon compartment. Anti-inflammatory medication often does not help resolve the symptoms of tendonitis and therefore although they are tried, often an injection is required. The maximum number of injections allowed in one year is three, preferably spaced no closer together than 6 months apart. Most patients have symptom resolution and return to their normal activities. A small number of patients fail a conservative nonoperative approach and require surgery involving a simple surgical release of the tight tendon compartment. This is done as an outpatient, often under local anesthesia, and always with a small incision. There are no formal restrictions after surgery. Patients return quickly to all their usual activities.