Wrist tendonitis, also called tenosynovitis, is a common condition characterized by irritation and inflammation of the tendons around the wrist joint.
The Anatomy of the Wrist Tendons
Tendons of the wrist fall into two broad categories:
- The flexor tendons on the palm side of the wrist, which flex or bend the fingers and wrist.
- The extensor tendons on the back (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 holds the tendons in place. On the dorsum, the extensor tendons are held in place by the extensor retinaculum. The tendons also run through a compartment called the tendon sheath.
Unfortunately, the tendons may be irritated from injury or repetitive use where they pass underneath the retinaculum. This irritation may cause swelling of the peritenon (tissue around the tendons), leading to rubbing and even more swelling. This inflammation is what causes wrist tendinitis.
Symptoms of wrist tendinitis include the following:
- swelling and tenderness over the tendons
- reduced wrist motion
- pain with use of the tendon
- creaking, or crepitus, at the wrist (which can be felt and/or heard)
Although any tendon may be affected, there are common patterns and manifestations of wrist tendinitis.
- The EPL, or extensor tendon to the thumb, is commonly affected where it goes around the corner of a bony prominence known as listers tubercle.
- The two wrist extensor tendons on the radial, i.e. thumb, side of the hand (the ECRL and ECRB) can become commonly irritated by repetitive motion.
- The two wrist flexor tendons (FCR and FCU) may also become irritated due to a variety of causes. The FCR runs in a particularly tight tunnel and is prone to irritation. It sometimes also becomes irritated in the presence of a ganglion cyst.
- The finger flexor tendons may become inflamed with repetitive use and gripping. Inflammatory disorders such as rheumatoid arthritis, lupus or gout can also cause irritation.
- The EPL and ECRL/ECRB may also become irritated where the tendons cross.
- On the little finger (ulnar) side of the wrist, the wrist extensor tendon (the ECU) may be inflamed.
- Inflammation of the APL and EPB on the radial side of the wrist is noted as Dequervains tenosynovitis.
- Additionally, 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 (covering around the tendons) and lead to tenosynovitis.
- Since the median nerve runs with the flexor tendons in the flexor tendon sheath and carpal tunnel, carpal tunnel syndrome may also be produced in association with this condition.
Initial treatment consists of:
- avoiding any aggravating activity
- utilizing anti-inflammatories and applying ice to the irritated area
- using a splint to rest the wrist (if prescribed)
f conservative treatment does not work, a careful cortisone injection next to the tendon may be helpful.
Finally, surgical treatment in the form of a tenosynovectomy may be required to provide relief.
- This surgery is performed on an outpatient basis 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 the closure of the skin, a dressing, and a 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 exercises are initiated.
Risks with surgery including anesthesia-related risks, wound healing problems or infection, and residual stiffness.