The wrist is a complex joint that not only moves the hand back and forth and side to side but also provides strength and flexibility to the hand and transfers forces from the arm to the hand (and vice versa). Made up of multiple bones, smaller joints, tendons, ligaments, nerves and blood vessels, the wrist is susceptible to numerous injuries and ailments. One common cause of wrist pain is tendonitis.

What is tendonitis of the wrist?

In medical terms, the suffix “itis” denotes inflammation. Hence, tendonitis is inflammation of a tendon and wrist tendonitis is the inflammation of one or more tendons in the wrist. 

Wrist Tendon Anatomy

Tendons are fibrous connective tissues that attach muscles to bones throughout the body. While strong enough to stand up to heavy loads and tensile forces, tendons are flexible enough to bend with joints and absorb shock in order to prevent muscle damage. 

Wrist tendons run along the back (dorsal) side of the wrist and the palm (volar) side of the wrist and connect forearm muscles to hand bones to aid in three main functions:

• Wrist flexion (bending the wrist forward and rotating the wrist)
• Wrist extension (bending the wrist backward or side to side)
• Finger motion

Types of Wrist Tendonitis

There are two general types of wrist tendonitis that encompass all of the specific tendonitis conditions.

Flexion Wrist Tendonitis

This condition affects the flexor tendons in the wrist and hand and is caused by repeatedly bending the wrist forward during physical activities, work or even sleep. One example of flexion wrist tendonitis is flexor carpi radialis tendonitis. 

Extension Wrist Tendonitis 

This type of tendonitis affects the extensor tendons in the wrist and hand and is caused by repeatedly bending the wrist backward during work, everyday activities and various sports. Two examples of extension wrist tendonitis are extensor pollicis longus tendonitis and extensor carpi ulnaris tendonitis. 

Symptoms

In addition to wrist pain that is usually described as a dull ache (versus a sharp, intense pain), symptoms typically include:

• Stiffness in the wrist joint
• Tenderness (especially when pressure is applied)
• Decreased range of motion
• Mild swelling
• A “creaking” noise when moving the wrist joint
• Weakness when gripping, pinching, typing, etc. 
• Inability to bear weight
• Tearing, popping or snapping with movement of the wrist joint
• Bruising and warmth

Wrist pain and symptoms of tendonitis are typically more pronounced first thing in the morning after waking up.

Risk Factors and Causes

There are some risk factors that can increase the risk of developing this condition. 

Risk Factors

• Metabolic disorders: diabetes, obesity, high cholesterol,
• Medications: frequent use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids
• Age and/or flexibility 
• Genetic disorders
• Work or sport that requires repetitive movement

Common Causes

• Acute wrist tendon injury: sudden impact or bending of the wrist
• Repetitive injury: any activity that causes repetitive motion of the wrist that can build up over time

Many sports, such as climbing, tennis, golf and baseball can cause wrist tendonitis. Repetitive work-related motions, such as typing, using a computer mouse, painting and other manual labor, can also cause tendonitis in the wrist.

Nonsurgical Treatments

Most tendonitis injuries can be treated non-surgically and heal in a few days to a few months, depending on severity. The first step in tendonitis treatment is rest and ice. If necessary, use a wrist brace for tendonitis, splint or sling and avoid all irritating activities. 

It’s important, however, to slowly work in small tasks as symptoms subside, as tendon fibers are repaired via movement. 

Physical Therapy Exercises

Most orthopedic wrist specialists will prescribe physical therapy, specific wrist exercises to promote tendon healing or even occupational therapy to correct functional behaviors that can cause wrist tendonitis. In addition to stretching, common wrist tendonitis exercises include eccentric exercises and light-load exercises.

Eccentric Exercises

Meant to stimulate collagen and limit inflammation, eccentric exercises are slow, lengthening muscle contractions that allow the muscle to elongate under tension. 

Lighter Loads

Paradoxically, physical therapy exercises are typically high-rep and low weight. Performing eccentric exercises with a lighter load for more repetitions is beneficial to tendon recovery. 

When is Surgery is Necessary?

While rare, surgery for this condition is an option when non-surgical treatments fail. Surgery is recommended when the tendon is ruptured or the tendon is a risk of tearing, the tendon has degenerated (tendinosis) or symptoms have not subsided after three to six months of physical therapy and other nonsurgical treatments. 

Depending on your injury, your surgeon will either perform a minimally invasive arthroscopic procedure or opt for an open surgery to address more severe tendon injuries. 

If you’re suffering from wrist pain or if you’re wrist tendonitis is affecting your day-to-day life, Dr. Karen Heidencan see you at our Salt Lake City, Park City, and Heber City orthopedic clinics.