(Also known as Wrist Tendinitis, Wrist Tendinopathy)
N.B. Although recent research suggests that 'wrist tendinopathy' is a more appropriate term to describe overuse injuries to the wrist tendons, we will use the term 'wrist tendonitis' in this document as it is more widely known.
What is wrist tendonitis?
Wrist tendonitis is a relatively common overuse condition which may affect one or more wrist tendons and is characterized by inflammation and swelling of the affected tendons.
The forearm comprises of two long bones known as the radius and the ulna. These bones connect with several small bones known as the carpal bones forming the wrist (figure 1). Many muscles of the wrist and hand originate from the radius and ulnar and cross the wrist to insert into the bones of the wrist, hand and fingers via the wrist tendons. These muscles fall into two broad groups known as the wrist and finger flexors (which lie on the palm side of the forearm and wrist) and the wrist and finger extensors (which lie on the opposite side of the forearm and wrist) (figure 2). Generally, the wrist and finger flexors are responsible for bending the wrist and fingers (e.g. making a fist), whilst the wrist and finger extensors are responsible for straightening the wrist and fingers and bending them backwards. Collectively, the muscles are responsible for gripping activity, general movement and use of the wrist and fingers.
Figure 1 – Relevant Anatomy for Wrist Tendonitis
Figure 2 - Relevant Muscular Anatomy for Wrist Tendonitis
During contraction of the muscles of the wrist, tension is placed through the wrist tendons. When this tension is excessive due to too much repetition or high force, damage to the wrist tendons may occur. Wrist tendonitis is a condition whereby there is damage, with subsequent inflammation and degeneration to one or more of the wrist tendons. This is usually due to gradual wear and tear associated with overuse, however it may also occur traumatically due to a specific incident.
Causes of wrist tendonitis
Wrist tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the wrist tendons. These activities may include sports such as gymnastics, golf or racquet sports as well as manual work such as carpentry, painting, chopping wood, bricklaying, repetitive use of a hammer or screw driver, use of vibrating machinery, sewing and knitting or working at a computer. Wrist tendonitis may also occur from other activities involving forceful or repetitive gripping of the hand.
It is common for patients to develop this condition following a sudden increase in activities that place stress on the wrist tendons or due to a change in these activities. Occasionally, wrist tendonitis may develop suddenly. This can be due to a fall onto an outstretched hand or due to a forceful movement involving heavy lifting or a gripping force through the wrist. A history of wrist, elbow, shoulder, neck or upper back injury may increase the likelihood of a patient developing this condition.
Signs and symptoms of wrist tendonitis
The symptoms associated with this condition usually develop gradually over a period of time. Initially, symptoms may present as an ache or stiffness in the wrist and hand following an aggravating or unaccustomed activity. This may often be felt at night or first thing in the morning and may warm up with heat and movement in the early stages. As the condition progresses, pain may be felt with every day activities involving the wrist and fingers such as carrying groceries, opening jars, shaking hands or using the computer. Patients with wrist tendonitis may also experience swelling, crepitus or pain on firmly touching the affected wrist tendons.
Occasionally, pins and needles or numbness in the fingers may be experienced along with weakness in the fingers and hand. This may present as difficulty performing fine movements of the hand, reduced grip strength, or an increased frequency of dropping objects. Wrist tendonitis may also be associated with neck or upper back pain on the same side.
Diagnosis of wrist tendonitis
A thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose wrist tendonitis. Further investigations such as an X-ray, Ultrasound, MRI or CT scan may be required to assist with diagnosis and assess the severity of the condition.
Treatment for wrist tendonitis
Most cases of wrist tendonitis settle well with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Activities which place large amounts of stress through the wrist tendons should be minimized, these include: racquet sports, gripping activities, opening jars, cans or doors, carrying or lifting. Resting from aggravating activities ensures that the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with this condition is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
Patients with wrist tendonitis will usually benefit from following the R.I.C.E. Regime. The R.I.C.E regime is beneficial in the initial phase of the injury (first 72 hours) or when inflammatory signs are present (i.e. morning pain or pain with rest). This involves resting from aggravating activities (often with the use of a Wrist Brace), regular icing, the use of a compression bandage and keeping the arm elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Manual "hands-on" treatment from a physiotherapist, such as massage, trigger point release techniques, dry needling, joint mobilisation, stretches, and electrotherapy, can assist with hastening healing, improving range of movement, pain and function and correcting factors that have contributed to the development of wrist tendonitis.
Patients with wrist tendonitis should perform specific flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.
In the final stages of rehabilitation, a gradual return to activity or sport is indicated as guided by the treating physiotherapist provided there is no increase in symptoms.
Prognosis of wrist tendonitis
With appropriate management and physiotherapy, most minor cases of wrist tendonitis that have not been present for long can usually recover within a few weeks. In more severe and chronic cases, recovery can be a lengthy process and may take more than 6 months in those who have had their condition for a long period of time. Early physiotherapy intervention is therefore vital to hasten recovery.
Contributing factors to the development of wrist tendonitis
There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
- excessive training or activity
- muscle weakness
- muscle tightness
- joint stiffness
- poor sporting technique or equipment
- inadequate warm-up
- poor posture
- Injury to the neck, upper back and nerves
Physiotherapy for wrist tendonitis
Physiotherapy treatment for wrist tendonitis is vital to hasten the healing process, ensure an optimal outcome and decrease the likelihood of future recurrence. Treatment may comprise:
- soft tissue massage
- wrist bracing
- wrist taping
- joint mobilization
- dry needling
- ice or heat treatment
- exercises to improve flexibility, strength and posture
- training and activity modification advice
- technique correction
- anti-inflammatory advice
- devising an appropriate return to activity plan
Other intervention for wrist tendonitis
Despite appropriate physiotherapy management, some patients with wrist tendonitis do not improve. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, corticosteroid injection, autologous blood injection or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.
Exercises for wrist tendonitis
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms during the exercises or after with rest.
Wrist Flexor Stretch
Keeping your elbow straight, take your wrist and fingers backwards using your other hand until you feel a mild to moderate stretch pain free (figure 3). Hold for 15 seconds and repeat 4 times provided there is no increase in symptoms.
Figure 3 – Wrist Flexor Stretch (right side)
Wrist & Finger Extensor Stretch
Keeping your elbow straight, curl your wrist and fingers up using your other hand until you feel a mild to moderate stretch pain free (figure 4). Hold for 15 seconds and repeat 4 times provided there is no increase in symptoms.
Figure 4 – Wrist & Finger Extensor Stretch (right side)
Tennis Ball Squeeze
Begin this exercise holding a tennis ball (figure 5). Squeeze the tennis ball as hard as possible and comfortable without pain. Hold for 5 seconds and repeat 10 times provided there is no increase in symptoms.
Figure 5 – Tennis Ball Squeeze (right hand)
Physiotherapy products for wrist tendonitis
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
- Wrist Braces
- Sports Tape (for protective taping)
- Ice Packs and Heat Packs
- Resistance Band (for strengthening exercises)
- TENS Machines (for pain relief)
To purchase physiotherapy products for wrist tendonitis, click on one of the above links or visit the PhysioAdvisor Shop.
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Wrist tendonitis is a relatively common overuse condition which may affect one or more wrist tendons and is characterized by inflammation and swelling of the affected tendons. Diagnosis and treatment by a physiotherapist is vital for an optimal outcome.
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