Background & Etiology
A tendon is part of the muscle that attaches the muscle to bone. It is a strong, fibrous tissue that is responsible for transferring the forces generated by the muscle to the bone, thus producing movement at the joint. When a tendon becomes irritated or inflamed it becomes painful, especially with movement. Inflammation of the tendon is called tendinitis.
Tendinitis in the wrist occurs when the tendons in the forearm that pass through the wrist joint and into the hand, become inflamed. Tendons in the wrist include the flexor tendons that bend the fingers and wrist (flexor digitorum profundus and superficialis, flexor pollicis longus, flexor carpi radialis and ulnaris, Palmaris longus) and the extensor tendons that extend the fingers and wrist (extensor digitorum, extensor indicis, extensor digit minimi, abductor pollicis longus, extensor pollicis brevis, extensor carpi ulnaris, extensor carpi radialis brevis and longus)
Tendinitis is most often caused by an overuse repetitive strain injury (RSI). Other high risk activities or conditions that can lead to the development of wrist tendinitis include:
- Participating in athletic activities that can strain the wrist and hand, like tennis and gymnastics.
- Repetitive strain injuries (RSI) at work occur in people who have jobs that require performing activities of a repetitive or forceful nature, like working an assembly line or heavy tool use.
- Sudden trauma or an accident like a fall where an individual puts their hands down to catch themselves, putting pressure on their wrists.
- Patients with rheumatoid or osteoarthritis may be susceptible to tendinitis
- Sustained gripping and grasping activities
- Wrist pain or tenderness directly over the tendon that can radiate to the hand or forearm
- Pain or burning sensation during activities
- Difficulty dressing and performing activities of daily living
- Weakness may occur as the inflammation gets worse
- Feeling of tightness or loss of motion due to discomfort
- Swelling of the tendon
- Loss of motion at the wrist
If an individual suspects they have tendinitis, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, possible splinting, ice, physical therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to correct any mechanical causes of the tendon irritation.
Hand Therapy Interventions
Hand Therapists are occupational therapists or physical therapists who, through advanced study and experience, specializes in treating individuals with conditions affecting the hands and upper extremity. A hand specialist may also have advanced certification as a Certified Hand Therapist (CHT). A qualified hand therapist is educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client.
Common interventions in the treatment of Wrist Tendinitis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage, manual stretching and joint mobilization by a hand therapist to regain mobility and range of motion of the wrist and tendon.
- Splinting: Fabrication of custom-made splint or fitting of pre-fabricated splint to rest, position and stabilize the affected area to allow for healing as well as support during functional use of hand.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the wrist and effected muscle.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve or modify movement technique and mechanics (for example, throwing, gripping, grasping, fine motor, and lifting activities) in daily use of the involved upper extremity.
- Modalities that can include the use of ultrasound, paraffin, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the wrist and tendon.
- Home program that includes strengthening, stretching and stabilization exercises and instructions/modifications to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy that include:
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Surgery to correct underlying pathology or the cause of the tendinitis
- Splinting to rest or immobilize the wrist and effected tendons
Most people recover full function following a course of conservative care that includes hand therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of tendinitis.
It is easier to prevent tendinitis than to treat it. Below are some tips to reduce the risk of tendinitis.
- Warm up lightly before activity to improve circulation and lubricate the muscle and tendon. Warm up should be performed to the area that will be used.
- Stretch the tendons and muscles you will be using after your warm up prior to the activity, and after it. Do not bounce when stretching. Instead, hold the stretch for 15-20 seconds.
- Strengthen the muscles and tendons that you need to use for your activity. A regular strengthening program three times a week will keep muscles prepared for the job you are asking them to perform.
- Do not work through pain. Listen to your body. Avoid the “no pain, no gain” philosophy.