Tendonitis is the irritation or inflammation of a tendon, and the tendons in the hand and wrist are highly susceptible to this condition. Tendons are flexible, cord-like structures that connect muscle to bone, enabling joint movement. When these tissues are overworked or strained, the resulting microtrauma leads to inflammation and pain, often making simple, everyday movements difficult. This condition frequently results from repetitive strain, which causes tendons and their protective sheaths to rub against surrounding structures, initiating the inflammatory response.
Specific Forms of Hand and Wrist Tendonitis
The hand and wrist contain a dense network of tendons, leading to several specific forms of tendonitis. One of the most frequently diagnosed is De Quervain’s Tenosynovitis, which affects the two tendons controlling thumb movement on the thumb-side of the wrist. This condition involves the thickening of the protective sheath surrounding the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons as they pass through a narrow tunnel.
Another issue is Trigger Finger (stenosing tenosynovitis), which occurs when inflammation causes the flexor tendon sheath in the palm to narrow, preventing the tendon from gliding smoothly. When the tendon catches during movement, the finger or thumb may lock or snap upon straightening. Intersection Syndrome is a less common form causing pain a few inches up the forearm, where the tendons responsible for extending the thumb cross over the tendons that extend the wrist. Repetitive movement at this crossing point causes the tendons to rub against one another, leading to tenosynovitis.
Factors That Lead to Hand Tendonitis
The primary driver of hand and wrist tendonitis is repetitive strain, where the continuous repetition of a motion exceeds the tendon’s ability to recover. Many occupations and hobbies involve a high rate of repetition, such as prolonged typing, assembly line work, gardening, or playing musical instruments.
Poor ergonomics and posture contribute by placing the tendons in awkward positions that increase friction and mechanical stress. For example, using a computer mouse or keyboard without adequate wrist support forces the wrist into a bent position, straining the tendons over extended periods. A sudden, sharp increase in the intensity or duration of an activity, such as beginning an intense new sport, can also overwhelm the tendons and trigger inflammation.
Certain underlying medical conditions can predispose an individual to tendonitis by affecting the health and structure of the connective tissues. Inflammatory conditions like rheumatoid arthritis can directly cause tendon sheath inflammation in the hands and wrists. Metabolic disorders such as diabetes also impact the tendons, making them more vulnerable to injury from mechanical stress due to changes in tissue composition.
Identifying the Symptoms
Hand and wrist tendonitis typically begins with a gradual onset of pain that worsens with specific movements. This pain can manifest as a constant dull ache, a sharp, stabbing sensation during movement, or a burning feeling along the tendon’s path. The affected area often feels tender to the touch, and the skin over the inflamed tendon may feel warm.
A common sign is stiffness, which is often most noticeable first thing in the morning or after a period of inactivity. Mild swelling may be visible around the wrist or at the base of the fingers, indicating fluid buildup in the irritated tendon sheath. Some people report a grating, squeaking, or crackling sensation, known as crepitus, when they move the joint. If these symptoms persist or interfere significantly with daily function, seeking professional medical evaluation is advisable.
Initial Steps for Relief and Recovery
Initial management of hand and wrist tendonitis focuses on reducing inflammation and preventing further irritation of the tendon. The R.I.C.E. protocol is an effective starting point, adapted for the hand and wrist area:
- Rest involves temporarily avoiding the specific activities that cause pain to allow the microtrauma in the tendon to begin healing.
- Applying an ice pack to the painful area for 10 to 20 minutes several times a day can help reduce both pain and local swelling.
- Compression can be achieved using a light elastic bandage or a specialized brace, which provides support and helps to limit swelling without restricting circulation.
- Elevation of the hand above heart level whenever possible also assists in draining excess fluid from the inflamed tissues.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used to manage pain and decrease the inflammatory response in the early stages. The use of a splint or brace can be beneficial, as it physically restricts movement, providing necessary immobilization to the irritated tendon. Making small ergonomic adjustments, such as ensuring proper wrist alignment while working at a computer, can significantly reduce the mechanical stress on the healing tendons. Persistent or severe symptoms may require professional treatment, which can include physical therapy, cortisone injections, or other medical interventions.