WRIST TENDONITIS

CONDITION

Tendons are thick bands of fibrous tissue that connect muscle to bone. Wrist tendonitis happens when any of the tendons around the wrist get irritated and swollen (Figure 1 below). The wrist is a complex joint made up of the ends of your forearm bones (radius and ulna) and many small wrist bones (carpal bones). There are many muscles and tendons that cross the wrist from the forearm and move the hand and wrist.

Figure 1

When tendons become irritated they do not slide across the wrist or through the surrounding tissues well.
Wrist tendons slide between other soft tissues and through slipper tunnels called tendon sheaths. Irritation, swelling and scarring can lead to friction in these tissues when the tendon moves.
One or more tendons on the palm side or back side of the wrist or below the thumb can be affected.

Causes

Repetitive bending at the wrist is the most common cause of wrist tendonitis. Overuse leads to microscopic injury of tendons that results in irritation and swelling. This makes it hard for tendons to glide or slide smoothly when the muscles to which they are attached contract to move a joint.Other risk factors for wrist tendonitis include:

smoking
being age 30 or older
being out of shape
using improper lifting or sports technique
having systemic diseases such as rheumatoid arthritis, gout or thyroid problems.

Anything in sports, at work or at home that requires you to move your wrist in the same direction over and over again can cause tendonitis. Examples include:

racquet sports, bowling, rowing
excessive typing
manual labor and working on production lines
working as a mechanic
picking up a new baby
painting
pulling weeds.

Symptoms and Signs

You will have pain over your affected tendons, especially when you are using them to perform the activity that most likely caused the tendonitis.
Pain usually occurs during and after the activities that require you to use your injured tendons. You may have aching, throbbing, burning and occasional sharp pains when your tendons catch.
Pain in your tendons usually starts slowly and persists or builds up over time.
Pain that happens immediately after a fall or another injury is more likely an injury or tear to a tendon, ligaments (soft tissue bands that attach bones to bones) or bone.
You will probably notice stiffness after periods of rest (when you did not use your hand and wrist much for a few hours) or the morning after you used your hand and wrist a lot.
You may notice that your tendons are swollen and warm.
Sometimes, you notice crunching and clicking where your tendon is getting caught up on tissues around it while it moves or slides.

WHEN TO CALL YOUR DOCTOR

Call your doctor right away (day or night) if:

If you have severe pain and swelling that makes it difficult for you to move your wrist.
If you have redness, swelling, warmth and fever, which means you may have a skin or tendon infection.

Call your doctor during regular office hours if:

You have mild to moderate pain and/or swelling and you are not getting better after four to six weeks of trying the things listed below under home care.
You notice numbness, tingling or loss of sensation in any part of your hand or wrist.
You have pain at night, which can be a sign of a more serious problem such as a growth in one of your bones.
Your pain started suddenly after a fall or other injury.
You also have pain in your upper arm and neck. This could mean that you have an injury to these areas, which can cause wrist pain.

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SELF-CARE AT HOME

Back off from activities that are causing your pain to the point where your wrist feels better.
Change the way you lift things to minimize your symptoms.
If the tendons on the back of your wrist are affected, lift things with your palm facing up.
If the tendons on the palm side or front of your wrist are affected, lift things with your palm facing down.
Until your wrist is better, avoid twisting motions that increase your symptoms.
When using your wrist, keep it in a neutral position with your wrist held straight, not bent toward your thumb or pinky finger.
Use your other hand and wrist as much as possible to rest your hurt wrist.
Using a chair with arm rests and back support that encourages good posture and a wrist support, if you work at a keyboard, can sometimes decrease your symptoms.
Place an ice pack or cold pack over your affected tendons for 20 minutes, three to six times daily to decrease pain and swelling.
Place a thin washcloth between the cold pack and your skin to minimize the risk of frostbite. You can hold the cold pack in place with an elastic wrap.
If you are busy, you may choose to ice during meals so as to save time and avoid interrupting other activities.
You may take an anti-inflammatory medication such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) for pain and inflammation. (See the labels for doses and risks.)
You may try these medications for two to four weeks if there is no medical reason you cannot take them.
If you develop stomach upset or other side effects listed on the label, stop the medicine and call your doctor.
If you have swelling or throbbing in your wrist, elevate it above the level of your heart by placing your elbow, with a pillow underneath it, on a table or the armrest of your chair or couch when you or sitting. Do this anytime you can for as long as you can.
If you have to keep doing activities such as at work that make your symptoms worse, you may use a neutral-position wrist splint, available at most drug stores (Figure 2 below).

Figure 2

If the tendons on the thumb side of your wrist are affected, you may need to use a splint that holds the thumb still.
If you have severe pain and swelling over your tendons, you may wear a splint to rest the wrist until you see your doctor.
Wearing a splint for more than a week or two can cause wrist stiffness and sometimes make your injury worse.
You may try gentle wrist stretches one to times daily, repeating each stretch two to three times, and holding stretches for 20 to 30 seconds.
Stretch just until you feel a slight pulling or discomfort in your affected tendons.
Make your stretches smooth and don’t bounce or force stretches. Stretches that are best for your affected tendons are usually performed by bending the joint and hand that the tendon crosses away from or to the opposite side of the involved tendons.
Two common stretches are pictured in Figure 3 below.

Figure 3

You may try gentle strengthening exercises using a small weight (such as a soup can) or something to provide resistance (like a bungee cord).
Let your pain be your guide: if it hurts, don’t do it.
Start by doing 10 to 15 repetitions of each exercise.
Move slowly in both directions.
Take a brief rest between exercises and repeat each exercise two to three times.
The number of repetitions and weight can be gradually increased as your symptoms allow.

Two common wrist strengthening exercises are pictured in Figure 4 below.

Figure 4

PREVENTION

Avoid activities that cause a lot of pain over your wrist tendons, and take it slowly when you start new activities.
If you use your hands and wrists a lot, stretching your wrist tendons regularly may help prevent wrist injuries.
Make sure your work station is set up properly. Some companies have experts in ergonomics, the science of fitting your workspace to your body. If your does, ask for an evaluation of your work station.
Use proper sports and lifting techniques.

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FOR MORE INFORMATION

REFERENCES

Tiedeman J, Ferlic T: Hand and Wrist Injuries. In Mellion M, Walsh M, and Madden C, et al: Team Physician’s Handbook, 427-440, Hanley & Belfus, Philadelphia, 2002.
Wainstein J: Tendonitis and tendinosis of the elbow, wrist, and hands. Clinics in Occcupational and Environmental Medicine 5(2) 299-322, 2006.

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Authored by Christopher Madden, M.D.

Favorably reviewed by The American Medical Society for Sports Medicine

http://amssm.org

Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.