Tendonitis of the wrist is a very common cause of wrist pain frequently associated with overuse activities although it can be caused by injury. Tendonitis, also known as tenosynovitis, can involve either the flexor or extensor tendons of the wrist and is a process of inflammation that develops around the tendons within their compartments. As tendons cross the wrist joint, the tendons move through tendon compartments made of fibrous tunnels or sheaths which contain fluid that provides for nourishment and for smooth gliding of tendons. Once inflammation occurs within the tendon sheaths, the tendons are unable to glide smoothly and become constricted due to thickening of the sheath. Any movement of the tendons then becomes painful. If also associated with an injury, an instability of the tendon compartment can occur which may result in snapping of a tendon over bone with certain rotations of the wrist. The process of tendonitis usually involves a single tendon compartment of the wrist, but it can involve multiple compartments and tendons.
A common tendonitis of the wrist involves the extensor tendons to the thumb called de Quervain’s tenosynovitis. Sharp pain occurs along the thumb side of the wrist and is most pronounced with certain rotations of the wrist and thumb. Women with a newborn child frequently develop this problem from the constant lifting with caring for their child. However, it can be caused by numerous activities of overuse.
Tendonitis of the wrist is often treated successfully with conservative measures including rest, stretching exercises, use of anti-inflammatory medication, and corticosteroid injection (also known as “cortisone” injection). Modification of activities with rest is best accomplished with use of a wrist splint. Stretching exercises for the wrist and forearm are initiated on a home basis or in conjunction with a Hand Therapist. Stretching is also encouraged on a long term basis as a means of prevention. If medically able, a nonsteroidal anti-inflammatory medication is prescribed for a period of time which can reduce inflammation and pain. However, for some conditions of tendonitis, corticosteroid injections, a more effective anti-inflammatory, may be recommended on a limited basis. In a small percentage of patients, tendonitis of the wrist may not fully respond to treatment or may become recurrent despite periods of improvement. For those patients who fail conservative treatment, surgery may be necessary to release or open the tendon sheath which permits pain-free motion of the tendons. Surgery can be very successful. Dr. Katz will discuss these various options to help you choose the treatment that is best for you.