Wrist Tendinitis or the more proper name, Tendinopathy, is a common condition that causes pain and limited function on either side of the wrist. The term tendonitis often refers to acute inflammation of the tendons that cross the wrist into the hand and the term tendinopathy is often used for ongoing more chronic conditions. This irritation to the tendon often causes difficulty with use of hand including gripping, grasping, and fine motor function like writing and typing.
Tendons are normally very strong, ropelike structures that attach between the muscles and the bones and cause our fingers, hands and arms to move when the muscles contract. The onset of symptoms is commonly due to large increases in physical activity that loads the tendon much more than what it is normally used to. This can be something simple such as typing with your wrist at an over extended angle or performing heavy gardening activity for the first time in a while. When this breakdown occurs at a higher rate than the body can repair it, the result is often pain, inflammation and limited function. When the tendons are in a more chronic state of overload, they can begin to break down and have lower tolerance to activity.
A variety of factors play a role in the development of tendonitis such as age, sex, biomechanics, conditioning/fitness, prolonged inactivity, hormones, genetics, medications, and body composition.
The symptoms of tendinopathy often consist of pain, swelling, stiffness, or warmth in the wrist associated with activity or specific movements usually involving finger or wrist movements. These symptoms are almost always located directly at the site of the effected tendon and are made worse by heavy gripping, twisting motions like removing a lid to a jar, or prolonged/new use of a tool. The wrist range of motion may be limited especially in the direction of stretch to that muscle/tendon. Athletic activities that place high loads on the tendons such as rock climbing, tennis or golf can also lead to wrist tendon pain.
Wrist tendinopathy can be diagnosed by your primary care provider, an orthopedist, or a PT. A physical therapist can determine this diagnosis in the clinic at the time of your evaluation. The signs and symptoms of wrist tendinopathy can be determined and differentiated by a physical therapist from other wrist pathologies and be treated without imaging or additional consultation by an orthopedist. Once diagnosed by any of the above treating medical providers, physical therapy is the next step to reduce the irritability to the tendon and improve wrist/hand function.
There are a number of treatments available to help with tendinopathy. When the problem is in the acute stage or reactive stage, reducing the load and giving the tendon a break is very useful. This includes modification of the intensity, duration, frequency and type of activity and could include ergonomic changes, a splint, or taping to help reduce the load on the tendon. Over the counter non-steroidal anti-inflammatory medications (NSAIDs) are also found to be very effective in this phase. A graded return to activity and exercise are key to optimal recovery.
A physical therapist treating wrist tendinopathy will perform manual therapy including soft tissue and joint mobilization to the wrist, hand, and elbow to reduce to the stiffness and muscle guarding surrounding the irritated tendon. A physical therapist may also perform trigger point dry needling or provide skin taping to the area to assist in reducing the irritability to the tendon.
Muscular re-education is a necessary component of rehab and is done by performance of an exercise program designed to stretch, but also improve the function of the muscle in the wrist and hand through strengthening.
Exercise, particularly eccentric exercise, has been shown to improve both tendon structure and pain. The combination of a structured exercise program, a graded return to activity and improving the quality of movement are key in returning to the things the patients wants and needs to do.
At Results Physiotherapy, every therapist is knowledgeable in the treatment of wrist tendinopathy and capable of providing the necessary manual therapy and exercise to improve wrist function and get you out of pain. For an acute tendonitis, healing of the tissue requires approximately 6-8 weeks to heal, and more chronic wrist tendinopathies may take several more weeks to heal.
Recovery from wrist tendinopathy is possible, and is not a lifelong condition but factors like repetitive movement and performing new activities like working in the garden for several hours after not performing the activity recently can cause new or re-aggravation of previous injuries.
To prevent wrist tendinopathy from occurring, stretching the wrist and hand prior to and after exercise can be performed. If you plan on performing novel or not regularly performed activities such as working in the garden or moving heavy boxes for several hours, take breaks in the activity to stretch your wrist and hand at least every hour.