Tendinitis in wrist
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Wrist tendonitis, also called tenosynovitis, is a common condition characterized by irritation and inflammation of the tendons around the wrist joint.
Many tendons surround the wrist joint. Tendons on the top of the wrist are extensor tendons. They allow the hand to be placed in a “cocked-up” position. Tendons in the underside of the wrist are called flexor tendons. They allow the hand to bend down.
Wrist tendonitis usually affect one of the tendons, but it may also involve two or more. Often wrist tendonitis occurs at points where the tendons cross each other or pass over a bony prominence. A particularly common place for wrist tendonitis to develop is along the side of the thumb. This is called DeQuervain’s tenosynovitis.
The wrist tendons slide through smooth sheaths as they pass by the wrist joint. These tendon sheaths, called the tenosynovium, allow the tendons to glide smoothly in a low-friction manner.
When wrist tendonitis becomes a problem, the tendon sheath or tenosynovium, becomes thickened and constricts the gliding motion of the tendons. The inflammation also makes movements of the tendon painful and difficult.
The most common and consistent complaint of patients diagnosed with wrist tendonitis is pain over the area of inflammation.
Swelling of the surrounding soft-tissues is also quite common.
Diagnosis of wrist tendonitis is a made by looking for the characteristic signs of this problem. In addition, depending of the tendon that is inflamed, the physician can perform tests that stretch the area of concern to locate the precise source of inflammation.
Imaging techniques such as diagnostic ultrasound and MRI also can be useful.
Treatment for wrist tendonitis
Immobilization. Placing the wrist in a splint or a cast is usually the first treatment step. Wrist tendonitis is often due to recurrent irritation of the tendon and its sheath. By resting the tendon, the inflammation should decrease. Placing an ice pack on an area of inflammation may also be beneficial.
Anti-Inflammatory Medications. Non-steroidal anti-inflammatory medications will help control symptoms of pain, but more importantly they help in the treatment of wrist tendonitis to decrease inflammation and swelling of the soft-tissues.
Corticosteroid Injection. Corticosteroids are a powerful anti-inflammatory treatment option that is given by injection directly to the site of inflammation. Cortisone injections are safe, but can weaken tendons. Injections should be administered using ultrasound guidance. Oftentimes, if there is evidence that significant adhesions are present, hydrodissection technique is used. Large volumes of fluid are injected between the tendon sheath and the surrounding adhesions using ultrasound guidance to free up the tendon sheath from the surrounding inflammatory reaction. This is curative.
Surgery. Surgery is only done when these other treatment methods have failed to solve the problem. If that is the case, the area of tight tendon sheath that cause the painful and difficult tendon movements can be released. The inflammatory tissue can also be removed in an effort to create more space for the tendon to move freely.
More recently, newer treatments for tendonitis may be very effective and prevent the need for surgery. For isolated tendon problems, hydrodissection tendon release (injecting large volumes of fluid under ultrasound guidance into the tendon sheath to relieve the pressure- somewhat like angioplasty in an artery) can be effective.
Also, percutaneous needle tenotomy is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the fascia. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality fascial tissue is stimulated to grow with natural healing.
For more information about this procedure, visit our sister site:
Tendonitis TendonitisandPRP.com provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.
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