Wrist Tendonitis May Actually Be Tendinosis
Research suggests what is often diagnosed as tendonitis may actually be tendinosis.2–6 Tendinosis is a chronic, non-inflammatory condition where the tendons collagen fibers degenerate from chronic overuse without adequate time to heal.
However, tendinosis may often be overlooked due to:
- Similar symptoms. Symptoms such as pain, stiffness, and reduced strength occur in both tendonitis and tendinosis.1
- Chronic injury. When tendonitis becomes chronic, it may develop into tendinosis.2
- Similar cause. Both tendonitis and tendinosis can be caused by repetitive injury to a tendon.
Tendinosis is also more common than tendonitis.2
Tendons of the wrist connect muscles to bones. Tendons of the wrist flexors are found on the palmar side and help in bending the wrist forward. The tendons of the wrist extensors are found on the dorsal side and help in bending the wrist backward.
The wrists tendons are bundles of long fibrous bands of protein that connect a forearm muscle to a hand bone. Tendons of the wrist include:
- Tendons involved in wrist flexion, the action of bending the wrist forward/inward. These tendons also help in rotating the wrist.
- Tendons involved in wrist extension, the action of bending the wrist backward. These tendons also help move the wrist toward the thumb or the little finger.
- Tendons involved in finger motion, which go from muscle bellies in the forearm to bones in the fingers or thumb.
Pain On The Back Of Your Wrist It May Be Dorsal Wrist Impingement Syndrome
Its not uncommon that I see a patient who complains of pain along the back side of the wrist, which is worse when the wrist is fully extended . These individuals feel a pinching discomfort in the wrist while doing activities such as yoga, pushups, or simply lifting themselves from a chair.
There are several conditions that can cause this pain, such as a small ganglion cyst, tendinitis, ligament injuries, or something called dorsal wrist impingement syndrome. In dorsal wrist impingement syndrome, the capsule becomes thickened and gets pinched in the back of the joint when the wrist is extended. Specifically, the capsule is pinched between the extensor carpi radialis brevis tendon and the scaphoid bone.
When examined, these patients will have pain when the back of the wrist is palpated, and pain when the wrist is maximally extended. X-rays are usually obtained to rule out other injuries to ligaments or bones within the wrist. Some patients will improve with rest, activity modification, splints, or anti-inflammatories.
In recalcitrant cases, an MRI is useful to gain more information. However, while an MRI may show a ganglion, tendinitis or ligament tear, patients with dorsal wrist impingement syndrome typically have a normal MRI. This is because the condition is dynamic, and the tissue is only pinched during activities, such as the push-up position.
to view the full article in the Journal of Hand Surgery.
How Can I Treat Wrist Pain At Home
You may need to limit or stop activities that worsen wrist pain. Other at-home therapies include:
- Cold compress for acute injuries.
- Warm compress for chronic conditions.
- Hand exercises guided by occupational- or physical therapy-certified hand therapists.
- Over-the-counter nonsteroidal anti-inflammatory drugs , topical NSAIDs applied to the skin .
- Oral or injected corticosteroid medication.
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Immediate Action Required: Go To An Urgent Treatment Centre Or A& e If You:
- have severe wrist pain
- feel faint, dizzy or sick from the pain
- heard a snap, grinding or popping noise at the time of the injury
- are not able to move your wrist or hold things
- have a wrist that’s changed shape or colour
- have lost the feeling in part or all of your hand
These might be signs of a broken wrist.
What Causes Dorsal Wrist Syndrome
The cause of dorsal wrist syndrome is when the wrist bends backwards, generally past 35-degrees as seen in this gymnast, the cartilage and the ligaments in the proximal row or the very initial part of the wrist in this area here are damaged.
The reason theyre damaged is because the contact surface area of the joint goes from a large one-centimeter contact surface with a straight wrist into this very tiny one-millimeter contact surface when the wrist is bent and that creates damage to the cartilage along the wrist surface here and it creates damage to the ligaments along the wrist surface here, eventually leading to cracked cartilage, loose ligaments, and arthritis.
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How Can I Prevent A Wrist Sprain
Wrist sprains are hard to prevent, since they’re usually caused by accidents. Even the best-trained athlete can slip. But always make an effort to exercise safely.
Some athletes benefit from using wrist guards or tape. These may prevent the wrist from bending backward during a fall.
SOURCES:American Academy of Orthopedic Surgeons web site: “Wrist Sprains.” Davis, M.F., et al, Expert Guide to Sports Medicine, American College of Physicians Press, 2005. Rouzier, P., The Sports Medicine Patient Advisor, second edition, SportsMed Press, 2004.
Repetitive Stress And Movements
Overuse injuries where there is repetitive wrist motion are a common reason for wrist pain. The problem is that many people dont associate their wrist pain with these movements because theyve been doing them for years without thinking about it. Over time, and especially with infrequent breaks, these repetitive movements inflame the tissues around the joint and cause a host of issues. The patients we see are everyday people just like you who do repetitive lifting, turning of the wrist, gripping, or similar movements. This includes painters, mechanics, plumbers, knitters, and even athletes.
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When To Contact A Doctor About Wrist Pain
Its important to contact a doctor if:
- wrist pain is interfering with everyday activities
- numbness or tingling is becoming worse, and there is little or no feeling in the fingers or hand
- simple hand movements are no longer possible
- weakness makes holding things difficult
Complications of wrist pain can include weakness and a decreased ability to carry out activities such as gripping objects and using a keyboard.
After a physical exam and symptom review, a doctor may also diagnose wrist pain and the underlying condition using:
- Medical imaging scans: A doctor may order imaging scans, including X-ray, CT, and MRI scans.
- Arthroscopy: This procedure involves a small cut on the wrist. A surgeon will then insert a small instrument with a tiny camera attached through the cut. This will produce images that allow medical professionals to assess and diagnose what is causing wrist pain.
- Nerve conduction studies: These measure how fast nerve impulses travel through the forearm, wrist, and hand regions.
Typically, doctors will only order invasive diagnosis techniques after rest and recovery from an injury have been unsuccessful.
Understanding Wrist Dislocation And Treatment
Wrist dislocations are more serious than a sprain. When the wrist is dislocated, one or more of the bones inside the wrist has moved out of alignment, and will need to be moved back into place. This is called reduction.
In some cases, reduction can be accomplished externally with sedation. However, for more severe dislocation, surgery may be necessary to correctly align the wrist bones again. The goal of reduction is to ease the pain associated with dislocation as well as restore original alignment and ensure full rotation and function.
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Why Are The Wrists Tendons Prone To Tendonitis And Other Tendon Problems
The muscles and tendons of the forearm, hand, and wrist are at continual risk for injury due to a variety of factors, including participation in certain sports, repeated movements from house work, load-bearing activities, poor workplace ergonomics, and accidents. Other factors that may contribute to the development of wrist tendonitis are:
- Nerves. Small tendons of the wrist that are involved in fine movements may contain more nerve fibers and nerve-endings compared to other bigger tendons6sending more pain signals when the tendon tissue is damaged.
- Blood vessels. In general, tendons have less blood supply than their muscles.4 Tendons may also experience a break in blood supply when the muscles are contracted for long periods of time, such as while riding a motorcycle or bottle-feeding a baby.4 Lack of adequate blood supply to a wrist tendon on a regular basis may cause long-term wrist tendon pain.
- Heat. Tendons that go through repetitive use may experience up to a 10% rise in the tendons internal temperature.4 This phenomenon may put the wrists tendons at a risk for injury.
When tendonitis progresses to tendinosis, the tendon begins to degenerate.6
Treatment And Prevention Of Wrist Pain
Treatment for wrist pain depends on the cause of the pain and its severity. Options include:
- Home treatment: Often, simply resting the wrist as much as possible to allow it time to heal is effective. Doctors may also recommend pain-relieving medication and ice to reduce inflammation and pain.
- Splints: In some cases, wearing a wrist splint can help. Splinting may prevent certain wrist movements that cause irritation. A splint might also reduce the squeezing of the nerve.
- Exercises: Wrist exercises may help to manage wrist pain, depending on the type of pain. Certain exercises can stretch and lengthen muscles and tendons.
- Additional treatment: Corticosteroid injections, which decrease inflammation and reduce pain, can be effective in treating wrist pain.
- Surgery: The type of surgery a doctor may recommend will depend on the cause of the pain.
In some instances, doctors may recommend a person undertake physiotherapy as part of ongoing treatment.
Small lifestyle alterations may reduce a persons chances of developing wrist pain. These include:
- using proper posture when sitting at a workstation and keeping the wrists in a relaxed position
- considering a wrist-friendly keyboard, if a person spends long hours at the keyboard
- learning how to use hand tools properly, placing less stress on the hands and wrists
- taking regular breaks from using a keyboard
- using wrist guards to prevent injuries when participating in sports, such as skateboarding, snowboarding, and rollerblading
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Wrist Bursitis Causes & Anatomy
Bursas are all over the body, in places where soft tissues may rub against each other or the underlying bone. Wrist bursitis affects people who tend to put a lot of weight on their hands, for example, cyclists.
There are two bursas in the wrist the radial bursa and the ulnar bursa. The radial bursa surrounds the flexor pollicis longus tendon on the thumb and palm sides of the wrist.
The ulna bursa surrounds the tendons of the flexor digitorum superficialis and profundus muscles, more centrally on the palm side of the wrist.
Causes of bursitis are either sudden trauma, or repetitive strain/overuse. In the latter, the bursa becomes inflamed and swollen due to repetitive friction.
Common Wrist Pain Causes And Injuries
We use our hands and wrists for so much in everyday life. As a result, it can be very painful, challenging, and frustrating when we lose any of that function because of an injury. Orthopedic surgeons specialize in preventing, diagnosing, and treating disorders of the bones, joints, ligaments, tendons, cartilage, connective tissues, and muscles. This includes everything from treating acute and traumatic injuries to managing chronic pain and diagnosing diseases that can affect your long-term quality of life.
The most common causes of wrist pain that we see at Fort Worth Hand Center include:
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Here Are The Top Three Culprits And What You Can Do To Put A Stop To The Pain
Ever find yourself pausing to rub the achiness out of your wrists? Or maybe hurting hands are disrupting your daily activities. Hand and wrist pain is more common than ever, thanks to the prevalence of smartphones and computer use at work. But how do you know if your pain is caused by a condition like carpal tunnel syndrome? Many of the most common hand and wrist conditions share the same symptoms, but they have very different causes, says Geisinger hand surgeon Joel Klena, MD. They can originate in the muscle or the joint, and can be a result of genetics, general overuse or sudden impact.
Read on for the top three causes of hand and wrist pain and common ways to treat them:
Symptoms Of Wrist Pain
Wrist pain symptoms can vary depending on the cause. Some people may have pain that they describe as achy or dull, while others may have sharp pain. The location of the pain can also vary.
In addition to pain, other symptoms may develop. Symptoms of an injury, such as a wrist sprain, can include swelling and bruising.
Numbness, tingling, and hand weakness might also occur when pain is due to carpal tunnel syndrome.
Some people may develop the following symptoms:
- Stiffness: A person may feel this through their wrist and potentially in their fingers.
- Trouble gripping objects: Wrist pain may make grasping or holding on to objects difficult or uncomfortable.
- A clicking sound when moving the wrist: This can be more severe after periods of rest.
Depending on the cause, symptoms may be mild to start and worsen as time goes on.
At first, pain may only occur during certain activities. In time, as the condition worsens, the pain might occur even at rest. Numbness can also progress to the point where a person cannot feel cold or heat and may drop things.
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Find Help For Pressure Or Movement
Are you looking for a treatment option that can help reduce pain from bending or placing pressure on your wrist? Border Therapy Services offers physical therapy that can help. Our team will do a free screening to find out the source of your pain. Then, well build you an individualized therapy plan, and this plan may include helpful therapy techniques such as:
Preventing Hand And Wrist Injuries
Sports-injuries cant always be prevented, but there are some precautions you can take before stepping onto the field that will lower your risk of injury. Sports equipment and protective gear like wrist guards, gloves, and sports tape could prevent a traumatic hand or wrist injury. Routine stretching and proper rest can also lessen the severity of and prevent overuse injuries.
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Hand And Wrist Anatomy
The hand and wrist consist of dozens of bones, joints, ligaments, tendons, and muscles that need to work together seamlessly in a variety of positions hundreds of times a day. From performing minor repetitive tasks to suddenly stopping the force of the body during a fall, the hands and wrists are susceptible to pain and injury at all stages in life.
- The hand consists of several small bones called phalanges, metacarpals, and carpals.
- The wrist is where the radius and the ulna meet at the hand.
- Between these bones is capsule, cartilage, and ligaments that allow for movement.
The carpal tunnel is an area where several tendons and nerves pass through the wrist. In carpal tunnel syndrome, these nerves and tendons are compressed.
Another common problem is pain at the base of the thumb, usually later in life, from arthritis. This is called basal joint arthritis and can be treated with splints, injections, and reconstructive surgery, if needed.
Other common problems include bone fractures, dislocations, and inflamed tendons and ligaments from overuse.
Find Help For Wrist Pain When Bending The Wrist At Arrow Physical Therapy & Rehabilitation
At Arrow Physical Therapy & Rehabilitation, our team is committed to helping people reduce their pain as quickly as possible. Your pain-reduction process will typically begin with a free screening. This is intended to give us the chance to figure out whats causing your pain, and then, well use this information to create a personalized treatment plan for you. Your plan will be designed to provide you with benefits such as:
- Improved joint mobility
- Increased ability to do normal daily tasks
Take the next step to get our help with your wrist pain. Contact our team today for more information or to schedule an initial appointment.
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Types Of Wrist Tendonitis
Depending on the type of tendon affected, wrist tendonitis may be classified as7:
- Extension wrist tendonitis, a condition that results from repeatedly bending the wrist backward. Extensor carpi ulnaris tendonitis and intersection syndrome are examples of extension wrist tendonitis.
- Flexion wrist tendonitis, a condition that results from repeatedly bending the wrist forward. Flexor carpi radialis tendonitis is an example of flexion wrist tendonitis.
Tennis, golf, rock climbing, and rowing are some examples of sports that may cause these injuries. The tendon degeneration or inflammation triggers chemical changes that are sensed by nerves and relayed to the brain as pain signals.8
Special Tests And Procedures
Other tests and procedures depend on what your healthcare provider suspects.
For example, your provider may do a surgical biopsyremove tissue for examination in the labif they want to diagnose a bump on the wrist and imaging is inconclusive.
They can also perform other tests that may help with the diagnosis.
|Extremely high white blood cell count|
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When To See A Healthcare Provider
Certain signs and symptoms can indicate a more serious cause of your wrist pain. Get medical help if you have:
- Pain that lasts more than a few days
- Inability to straighten or flex the joint
- An inability to carry objects or use the arm
- Pain at night or while resting
- A deformed joint
- A hand or fingers that are bluish
Symptoms Of Hand Finger And Wrist Pain
Symptoms of hand, finger or wrist pain depend on the type of injury and mechanism of injury. The symptoms commonly include pain during use, swelling, and/or difficulty moving the affected area.
Treatment for hand, finger and wrist pain includes: over-the-counter pain medication, rest, ice, and elevation. In more severe injuries, immobilization or surgery may be necessary.
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