Wrist Joint Tendonitis: Causes, Symptoms, Treatment-Medications, PT, Surgery

Tendonitis of the Wrist joint is a painful condition caused by inflammation or injury of wrist joint tendons.

Tendon is a bundle of tough fibrous tissue. Tendon is an extension of muscles. Tendon is firmly attached to muscle fibers and at the other end tendon is anchored to the bone.

Tendon anchors muscles to bone so muscle can contract against the bone. During muscle contractions, the tendon pulls the bone towards the contracting muscles.

Tendons supporting wrist joint are located in front (anterior) of wrist joint and behind (posterior) the wrist joint. Tendons located in front of wrist joint are called flexor tendons and tendons located at the back of the wrist joint are known as extensor tendons.

Flexor Tendons– Flexor tendons are spread over the wrist bones in two layers known as superficial and deep layers of wrist joint tendons. The lists of flexor tendons are as follows-

• Brachioradialis
• Flexor Carpi Ulnaris
• Flexor Carpi Radialis
• Palmaris Longus
• Flexor Digitorum Superficialis
• Abductor Pollucis Longus

Extensor Tendons– Extensor tendons lie on back of the wrist joint. List of extensor tendons are as follows-

• Extensor carpi radialis longus.
• Extensor pollicis longus.
• Extensor carpi ulnaris.
• Extensor carpi radialis longus.
• Extensor carpi radialis brevis.
• Extensor digitorum.
• Extensor digiti minimi.
• Extensor indicis.

Causes of Wrist Joint Tendonitis Are As Follows-

Traumatic injuries as described below cause tendon injury, which often results in inflammation of tendon.

• Direct Impact.
• Twist and Turn of the Joint.
• Violent Extension or Flexion of the Wrist Joint.

• Tendon injury follows inflammation of tendon.
• Spread of infections from surrounding cellulitis.

• Tendonitis is often seen as a work accident when manual worker consistently use vibrating equipment.

• Repeated wrist joint motions while using keyboard of computer or continuous typing causes wrist joint tendonitis.

• Superficial tendon injury such as scratch or superficial laceration causes mild to moderate pain 
• Injury heals in 2 to 3 weeks.

• Partial tear of tendon causes moderate to severe pain.
• Pain may last for 4 to 6 weeks.
• Pain and post injury tendonitis responds to rest, restricted joint activities, and anti-inflammatory medications.
• Partial tear of tendon may heal with scarring of tendon
• Partial tendon tear may heal in 4 to 6 weeks.

• Complete tear of tendon causes severe to very severe pain 
• Pain may last for 6 weeks or longer. 
• Pain and post injury tendonitis responds to rest, restricted joint activities and anti-inflammatory medications.
• Complete tear may not heal and may need surgical repair or tendon transplant.
• Tendon tear may take long time to heal around 8 to 12 weeks.

• Chronic Wrist Joint Pain– Pain around wrist joint, pain intensity is increased with joint movements.
• Muscle Spasm of Injured Arm– Forearm and hand muscle spasm is often observed following severe pain and joint movements.
• Age– Most common over age 40 years.
• Wrist Joint Stiffness– Joint stiffness causes difficulties in flexion or extension of wrist joint.
• Range of Joint Movements– Patient often has difficulties to flex or extend the wrist joint depending on injury or inflammation of either flexor or extensor tendon.
• Pain During Change Of Joint Position– Severe pain is observed during change of position like sitting to standing position or getting in and out of car.
• Referred Pain– Pain is often felt in forearm or hand.

• Wrist Joint Tenderness– Tenderness and severe pain is felt on deep pressure over tendon either on flexor or extensor side of the joint. 
• Joint Range of Motion– Loss of maximum range of joint motion of the wrist joint is observed.
• Joint Stiffness– Stiffness observed during passive and active wrist joint movement.
• Skin Temperature– Skin temperature over inflame tendon is often increased and feels warmed. 
• Muscles of the Affected Limb– Loss of muscle mass or muscle atrophy in forearm and hand are observed in late stages.

Following investigations are performed to diagnose tendonitis or to rule out the other causes of wrist joint diseases resulting in similar pain.

• X-Ray is performed to rule out fracture and dislocations of the wrist joint.

• To isolate and observe swelling or tear of tendon.
• To rule out fracture of wrist joint.
• To rule out dislocation of wrist joint.
• To diagnose blood clots or soft tissue swelling associated with tendonitis or tendon tear.

• To rule out fracture of wrist joint.
• To rule out dislocation of wrist joint.

• White Blood Cell Count (WBC) – WBC count is increased in infected or septic wrist joint.
• Erythrocyte Sedimentation Rate (ESR) – ESR is increased in septic arthritis or cellulitis. ESR is also increased in wrist joint pain caused by rheumatoid or psoriatic arthritis. 
• Rheumatoid Factors (RF) – RF is increased in patients suffering with rheumatoid arthritis. 
• Citrulline Modified Proteins (Anti-CCP) – Increased in rheumatoid arthritis.
• HLA-B27 Genetic Marker– Test is positive in inflammatory wrist joint diseases like Psoriatic Wrist Joint Disease, Ankylosing Spondylitis and Reiter’s syndrome.

Treatment Choices to Cure Wrist Joint Tendonitis Are As Follows-

• Conservative Treatment.
• Medications.
• Physical therapy.
• Interventional Pain therapy.
• Surgery.

Following Conservative Treatment Are Often Suggested For Wrist Joint Tendonitis.

• Rest 
• Exercise of Forearm And Hand Muscles
• Heat or Cold Therapy

Following Symptoms Of Wrist Joint Pain Are Treated With Medications:

• Chronic Pain
• Tendon Inflammation
• Muscle Spasm
• Anxiety Disorder
• Depression

Chronic Pain is treated with one of the following medications-

• NSAIDs– Motrin, Naproxen and Celebrex.
• Opioids– Opioids are prescribed if NSAIDs are ineffective in relieving pain.
  1. Short Acting Opioids- Vicodin, Lortab and Norco.
  2. Long Acting Opioids- Oxycontin, MS Contin and Methadone.
• Antidepressant Analgesics– Treats neuropathic pain and pain not responding to opioids, Celebrex is one of the antidepressant analgesic.
• Antiepileptic Analgesics– Treats neuropathic pain and pain not responding to opioids, Neurontin and Lyrica are some of the antiepileptic analgesics. 

Tendon Inflammation is treated with following anti-inflammatory medications-

• NSAIDs– Ibuprofen, Naproxen, Daypro or Celebrex.
• Corticosteroids– Prednisone tablets or corticosteroid injection around tendon.

Following medications are prescribed for muscle spasm associated with wrist joint pain:

• Baclofen.
• Flexeril.
• Skelaxin.
• Robaxin.

Indications for Physical Therapy to Treat Wrist Joint Tendonitis Are As Follows:

• Pain.
• Muscle Spasm.
• Joint Stiffness.
• Joint Instability.

• Exercise– Patient will be taught to do exercise to maintain muscle tone, prevent muscle atrophy and reduce pain.
• Manual Therapy– Light or deep massage therapy often helps to improve blood circulation and thus rapid recovery from inflammatory disease.
• Heat and Cold Treatment– Joint or tendon swelling is treated with cold therapy and stiff joint movements are treated with heat therapy. Heat therapy includes infra red light treatment.
• Ultrasound Treatment– Ultrasound treatment helps to reduce pain and improve circulation.

Pain physician practices interventional pain therapy. Interventional pain therapy involves invasive treatment. Invasive treatments are putting a needle to inject medications, placing stimulator with the body tissue or any surgery.

Interventional pain therapies for wrist joint pain are divided in following two groups.

• Cortisone Injection Therapy– Chronic pain such as wrist joint tendonitis is treated with corticosteroid injection. Joint or tendon injection is performed in surgical center. Injections in few cases are performed under sedation depending on procedure and patient’s apprehension regarding needle.
• Advanced Interventional Therapy– Chronic pain not responding to pain medications, physical therapies or surgeries are treated with advanced interventional pain therapy. Advanced physical therapy includes placement of spinal cord stimulator in cervical epidural space or in rare cases insertion of pump to deliver pain medications in cerebrospinal fluid near cervical (neck) spinal cord.

Tendon tear is initially treated with conservative treatment and medication. Failed conservative treatment is often followed by surgical options of treatment.

• Tendon Suture– Torn tendon is brought together and sutured. Healing forms the scar tissue and heals the tendon tear.
• Tendon Reposition– If the Tendon is separated from its attachment then the tendon is repositioned and sutured to periosteum of the bone at nearest position.
• Tendon Transplant– Lacerated and torn tendon often looses length of its size and becomes short. Tendon from other location is excised and attached to injured tendon.

References:

Also Read:

• Tendonitis Wrist or Wrist Tendinitis: Causes, Signs, Symptoms, Treatment, Exercises, Tests
• Wrist Ganglion: Types, Causes, Symptoms, Treatment, Exercises
• Wrist Pain: 9 Major Medical Conditions that Cause Wrist Pain or Wrist Joint Pain
• Wrist Pain, Wrist Joint Pain: Symptoms, Treatment- Conservative, PT, Surgery, Prevention
• Wrist Joint Arthritis: Symptoms, Causes, Treatment- Medications, NSAIDs, PT, Surgery
• Wrist Joint Dislocation: Causes, Symptoms, Treatment- PT, Close Reduction, Surgery
• Treatment for Wrist Joint Pain: Conservative, Medications, PT, Surgery
• Wrist Joint Anatomy: Bones, Movements, Ligaments, Tendons- Abduction, Flexion
• Wrist Joint Fracture: Types, Causes, Symptoms, Treatment- Medications, PT, Surgery
• Wrist Pain Information Center