Article by Dr Manasa S, B.A.M.S
Wrist tendonitis is a common musculoskeletal condition characterized by inflammation in the tendons that link forearm muscles to the bones in the hand, affecting key movements such as gripping, lifting, and other repetitive actions. It can involve any of the six primary wrist tendons, leading to pain, stiffness, and occasionally, swelling. Often triggered by overuse or injury, wrist tendonitis can make even routine tasks difficult without proper management.
Incidence and Prevalence in the Community:
– General Population: Wrist tendonitis is a frequent condition, especially among individuals engaged in repetitive hand or wrist activities, such as athletes, manual labourers, and office workers.
– Occupational Impact: Jobs requiring extensive wrist motion, like typing, hairstyling, or machine work, see higher cases, making wrist tendonitis a notable occupational health issue.
– Gender and Age Factors: The condition is more prevalent among individuals over 40 and those assigned female at birth, due in part to factors like hormonal variations and caregiving activities.
– Specific Forms: De Quervain’s tendinitis, affecting the thumb side, and ulnar tendonitis, involving the ulnar side, are common variations, with the former often called “mommy’s wrist” due to its prevalence among new mothers and caregivers.
Symptoms of Wrist Tendonitis
– Dull, Aching Pain: A persistent, mild ache in the wrist, often more pronounced after waking.
– Stiffness: Increased stiffness in the wrist, especially noticeable in the morning.
– Tenderness: The wrist may feel tender and sore, especially when touched or pressure is applied.
– Mild Swelling: Visible puffiness around the inflamed area of the wrist.
– Reduced Range of Motion: Difficulty moving the wrist fully, with limited flexibility. Opening jars or turning door knobs, or lifting pets, babies or small children.
– Weakness: Performing everyday tasks (e.g., gripping, pinching, typing) may feel challenging or weak.
– Creaking or Clicking Sensation: A subtle cracking or clicking noise when moving the wrist due to tendon inflammation.
Causes of Wrist Tendonitis
Wrist tendonitis typically develops due to repetitive motion, lifestyle factors, or specific injuries. Some primary causes include:
- Repetitive Strain: Frequent activities that put stress on the wrist, such as typing, sports, or physical labor, can lead to overuse, a common factor in wrist tendonitis.
- Sudden Injury: Trauma like falling on an outstretched hand, bending the wrist, or impact injuries can inflame tendons, triggering tendonitis.
- Joint Misalignment and Weak Posture: Misaligned or poorly positioned wrist joints, often from ergonomics or poor posture, can increase stress on tendons.
- Underlying Conditions: Chronic conditions like arthritis, diabetes, and general age-related decline in flexibility can make the tendons more susceptible to inflammation.
- Poor Flexibility or Strength in Wrist Muscles: Weak or inflexible wrist muscles may fail to support tendons properly, leading to inflammation from strain.
Differentiating from Similar Conditions
It’s essential to distinguish wrist tendonitis from similar wrist ailments:
– Arthritis involves joint inflammation, while tendonitis affects the tendon itself.
– Carpal Tunnel Syndrome is caused by compression of the median nerve in the wrist, resulting in numbness and tingling, rather than the inflammation seen in tendonitis.
Risk Factors for Wrist Tendonitis
Wrist tendonitis can develop in people whose daily activities place significant stress on their wrists, especially through repetitive or high-impact motions. Certain factors increase the likelihood of experiencing wrist tendonitis, including:
– Age: Individuals over 40 are more prone to tendon inflammation due to natural wear and tear over time.
– Gender: Those assigned female at birth may be at a slightly higher risk, possibly due to hormonal or anatomical differences.
– Repetitive Job Tasks: Occupations that require repetitive wrist motions, such as cake decorating, hairstyling, heavy machinery operation, or typing, can contribute to strain on the wrist tendons.
– Certain Health Conditions: People with diabetes, osteoarthritis, rheumatoid arthritis, or gout have an increased risk of developing tendonitis due to joint or tissue inflammation associated with these conditions.
– Poor Posture: Improper positioning of the arm, wrist, or hand while typing, texting, or performing other tasks can place excess strain on wrist tendons.
– Smoking: Smoking can impair blood flow, reducing tendon resilience and increasing the likelihood of tendon damage.
– Participation in Strenuous Sports: Activities like gymnastics or basketball that require intensive wrist usage can lead to tendonitis.
– Previous Tendon Injuries: A history of tendon injuries or related issues, like lateral epicondylitis (pain on the outside of the elbow), can increase susceptibility to wrist tendonitis.
– Lifting and Holding: New mothers and childcare providers frequently develop wrist tendonitis, often called “mommy’s wrist” or de Quervain’s tendonitis, due to prolonged lifting and holding of babies.
– Starting New Activities Without Proper Conditioning: Engaging in new activities without gradually building wrist strength can place undue stress on the tendons.
– Ignoring Pain: Continuing an activity despite experiencing wrist pain may exacerbate the condition and lead to chronic tendon issues.
– Infections: Certain infections may also contribute to the risk of developing wrist tendonitis.
Diagnosis of Wrist Tendonitis
Physical Exam: Your healthcare provider will review symptoms and perform a physical examination, pressing on specific areas of the wrist, forearm, and hand to detect tenderness or swelling.
Movement Tests: Certain movements, such as forming a fist or rotating the wrist, may be requested to isolate areas of pain and identify the affected tendons.
Since wrist tendonitis symptoms can overlap with other wrist conditions, further evaluation may be necessary to rule out similar conditions, such as:
– Arthritis: Involves painful joint swelling and inflammation.
– Carpal Tunnel Syndrome: Caused by compression of a nerve in the wrist, often leading to numbness and tingling.
– Trigger Finger: Inflammation causes a finger to become stuck in a bent position.
– Wrist Fractures: Breaks in wrist bones can mimic tendonitis symptoms.
Imaging Tools for Accurate Diagnosis
– Ultrasound: Provides real-time images of the tendons, showing inflammation, thickening, or potential tears in the tendon sheath.
– MRI (Magnetic Resonance Imaging): Offers a highly detailed view of soft tissues, precisely locating any tendon inflammation or injury, which helps assess the severity of the condition.
– X-ray: While primarily used to view bones, X-rays can rule out fractures or joint-related issues that may mimic tendonitis symptoms, making them a useful initial tool.
These diagnostic tools allow healthcare providers to confirm wrist tendonitis and develop a targeted treatment plan based on clear, detailed imaging.
Management and Treatment of Wrist Tendonitis
Conservative treatment is often effective in managing wrist tendonitis. Common recommendations include:
– Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation. In some cases, steroid injections may be recommended to manage severe symptoms.
– Physical or Occupational Therapy: Therapists provide exercises to help restore strength, flexibility, and mobility in the wrist and fingers. They can also advise on pain-minimizing techniques for everyday activities.
– Rest: Resting the wrist is essential. Avoid activities that exacerbate the pain, such as heavy lifting, typing, or repetitive wrist motions, to allow the tendons time to heal.
– RICE Method: Rest, ice, compression, and elevation (RICE) can relieve symptoms at home. Apply ice to the wrist for 20 minutes every two hours, with the wrist elevated above heart level. Always use a towel between the ice and skin to prevent skin injury.
– Splinting: A wrist splint stabilizes and immobilizes the wrist, reducing movement and allowing the tendons to heal. Depending on the severity, a custom or over-the-counter splint may be recommended.
Surgical Intervention
If symptoms persist despite months of conservative treatment, surgery may be considered. Wrist tendon surgery typically involves:
– Removing damaged tissue from around the tendon sheath.
– Making small cuts in the tendon sheath to relieve pressure, allowing the tendon more freedom of movement.
Wrist tendon surgery is generally an outpatient procedure, with patients typically returning home the same day. Local, regional, or general anaesthesia may be used, and stitches are usually removed after approximately two weeks.
Risks of Surgery
Wrist tendon surgery is considered safe, but it carries potential risks, including:
– Infection
– Nerve damage
– Persistent pain or “pins-and-needles” sensation
– Incomplete wound healing
– Scar tissue formation
– Tendon subluxation (tendon displacement)
Prevention of Wrist Tendonitis
Proactive steps can reduce the likelihood of developing wrist tendonitis. Preventive measures include:
– Avoiding overuse of wrist tendons
– Quitting smoking
– Stretching the wrists before activities
– Taking regular breaks during repetitive tasks (e.g., typing)
– Using a wrist brace or splint if advised by a healthcare provider
Prognosis for Wrist Tendonitis:
With proper treatment, most individuals experience significant improvement and avoid long-term damage or persistent pain. Once the wrist has healed, physical or occupational therapy can play a crucial role in restoring strength and mobility, allowing individuals to resume daily activities with less strain. Therapists also provide guidance on maintaining proper technique and form, reducing the risk of re-injury.
However, having had a tendon injury increases the likelihood of re-injury. It’s essential to protect your wrists, particularly when engaging in sports or repetitive movements, and to heed any signs of pain as signals to rest and avoid further strain.
Living With Wrist Tendonitis
When to Contact Your Doctor:
It’s essential to reach out to your healthcare provider if you experience:
– Frequent dropping of objects due to grip weakness.
– Sudden, severe pain in the wrist, hand, or fingers.
– Difficulty making a fist or gripping objects.
– Swelling or unusual discoloration around the wrist.
– Inability to move your wrist or fingers.
Being attentive to these symptoms can aid in timely management and help prevent further complications.
Related Research and Studies
In a study – ‘Ergonomics considerations in hand and wrist tendinitis’ – the epidemiologic data show that the risk of hand and wrist tendinitis in persons who perform highly repetitive and forceful jobs is 29 times greater than in persons who perform jobs that are low in repetitiveness and force. Vicious deformation of the tendons and adjacent tissues is a possible factor in this relationship’.
In yet another study – ‘Prevalence of Wrist Tendonitis in Sub Elite Badminton Players’ – ‘the statistical analysis showed extremely significant relation between wrist tendonitis and sub elite badminton players with p value ˂ 0.0001.
Ayurveda Understanding of Wrist Tendonitis
Wrist joint is called Manibandha Sandhi in Ayurveda. It is an important joint which helps in movements of the hand and coordinates / bridges the movements of the forearm and hand. Hand is a Karmendriya – organ of action. Many actions and activities like holding, gripping etc are contributory to this indriya. In wrist tendonitis, this indriya is affected. Manibandha Sandhi also houses Manibandha Marma, which is predominantly a sandhi marma – predominantly made up of joints. But the other structures which are meant to be in a marma are also present but in lesser proportions i.e. muscles, tendons, ligaments, blood vessels and bones. This also shows the knowledge of Ayurveda that these structures related to the forearm and hand pass through the Manibandha Sandhi.
We do not have diseases or afflictions of wrist joints directly mentioned in Ayurveda, except those conditions mentioned by Acharya Sushruta in the context of injury to Manibandha Marma.
Injury to this marma is said to cause kunthata i.e. deformity of hand.
This can be considered as a Vata disorder. The causes like repetitive action and activities involving wrist joint and resulting repetitive strain, occupations that demand repetitive wrist movement, strenuous sport activities involving wrists, activities like prolonged lifting and holding, malalignment, wrong posture, sudden injury – all cause vata aggravation which may set up the pathogenesis of the disease. Gradually the marmas too would be involved. Involvement of pitta and rakta too should be considered in the pathogenesis since they cause inflammation.
Symptoms also point towards vata involvement, i.e. pain, stiffness, mild swelling, reduced range of motion, clicking sensation or sounds and weakness of joint.
Treatment principles include vata pacifying measures including medicines, therapies, food and lifestyle modifications. Snehana (Abhyanga, Dhara), Lepa, Upanaha, Virechana and Vasti form the mainstays of treatments towards effective management of Wrist Tendonitis. Dhanyamla Dhara and Ksheera Dhara are also beneficial.
If other diseases like Amavata, Sandhigata Vata, Vatarakta or Sotha are causal for this condition, these primary diseases should be promptly treated on the lines of treatments mentioned in those conditions. Likewise, treatment principles of Rakta Vrddhi, Pitta Vrddhi, Kandara / Snayugata Vata, Mamsagata Vata and Asthigata Vata also should be considered.
The rest of the understanding of the disease and its management should be understood on similar lines as explained in the below mentioned article.
Related Reading – ‘Extensor Tendonitis – Ayurveda Understanding’
