Tendons of the wrist fall into two broad categories: The flexor tendons on the palm side of the wrist which flexed or bend the fingers and wrist, and the extensor tendons on the back or dorsal side of the wrist which extend or straighten the fingers and wrist. the flexor tendons are covered by a thick band of tissue called the flexor retinaculum which hold them in place. On the dorsum the extensor tendons are held in place by the extensor retinaculum. The tendons run in a compartment called the tendon sheath. Despite lubrication, the tendons may be irritated from injury or repetitive use where they past underneath the retinaculum. this irritation may cause swelling of the peritenon or tissue around the tendons and produce rubbing and more swelling. This condition is called inflammation of the tendons or wrist tendinitis.
Symptoms of wrist tendinitis or swelling and tenderness over the tendons. Wrist motion may be reduced. there may be pain with resisted use of the tendon. There may be creaking, or crepitus, at the wrist which can be felt or heard. although any tendon may be affected, there are common patterns of tendinitis. The EPL, or extensor tendon to the thumb is commonly affected where it goes around the corner at a bony prominence known as listers tubercle. the two wrist extensor tendons on the radial or thumb side(ECRL and ECRB) can become commonly irritated at the wrist by repetitive motion. The EPL and ECRL/ECRB may also become irritated where the two cross. This does notice intersection syndrome. On the little finger or ulnar side of the wrist the wrist extensor tendon ECU may be inflamed. inflammation of the APL and EPB on the radial side of the wrist is noted as Dequervains tenosynovitis. For more information see the article on Dequervains. all of the extensor tendons may be affected by inflammatory disorders such as rheumatoid arthritis, lupus or gout, which can produce inflammation of the tenosynovium, or covering around the tendons, known as tenosynovitis.
The two wrist flexor tendon(FCR and FCU) they also become irritated. The FCR runs in a particularly tight tunnel at the end near its insertion and may become irritated there. It sometimes also becomes irritated in the presence of a ganglion cyst. the finger flexor tendons may become inflamed with repetitive use and gripping or with inflammatory disorders such as rheumatoid arthritis, lupus or gout. Since the median nerve runs with the flexor tendons in the flexor tendon sheath and carpal tunnel, carpal tunnel syndrome may also be produced.
Initial treatment consisted of avoiding the aggravating activity, anti-inflammatories and application of ice. A wrist splint may be used to rest the wrist. If conservative treatment does not work, a careful cortisone injection next to the tendon may be helpful. Finally surgical treatment in the form of tenosynovectomy may be required. this surgery is performed as an outpatient under local standby or twilight anesthesia. An incision is made over the tendon sheath of the affected tendon. The inflamed covering of the tendons, or tenosynovium, is peeled away, cleaning the tendons. The retinaculum is repaired and sometimes lengthened in order to provide room for the tendons. After closure of the skin, a dressing and splint are applied. Controlled range of motion of the tendons is usually started in therapy in order to avoid scarring or stiffness. at 6 weeks the splint is discontinued and aggressive strengthening initiated. Risks with the surgery including anesthesia related risks, wound healing problems or infection, residual stiffness.