Tendons are made up of tough bundle of fibrous tissue, which connects muscles and bones. Tendonitis of the hand causes severe pain with movement of the hand. Tendonitis is an inflammation of the tendon. Tendons of the hand are thin, flat and white in color. Inflammation of the tendon sheath results in trigger finger. Tendon may be normal or inflamed in Trigger finger disease. Tendon becomes swollen and rigid when tendon is inflamed.
Causes of Hand Tendonitis
Injury of the Hand Causing Hand Tendonitis
- Minor or major injuries of the hand often cause tendonitis.
- Penetrating injury results in partial or complete tear of the tendon.
- Tendon tear often follows inflammation and tendonitis.
- Hand injury is caused by fall on outstretched arm, direct impact to hand during work or auto accident.
- Hand injury may be associated with skin laceration, penetration or contusion of the hand.
- Laceration and penetration often results in hand infection followed by tendonitis.
Types of Tendon Injury-
- Minor Injury- Microscopic tears of the tendon follows tendon inflammation.
- Major Injury- Partial or complete tendon tear causes severe tendonitis.
Sports Injuries Causing Hand Tendonitis
- Repeated action causes tendon injury.
- Injury often is secondary to wear and tear of the tendon following forceful use of tendon several times a day and week.
- Baseball and basketball players handle the ball and use the muscles as well as tendon to throw the ball which eventually may sometimes result in tendon injury.
Overuse of Tendon at Work Leading to Hand Tendonitis
- Manual workers use heavy tools and vibrating tools, which often causes inflammation of the tendons of the hand.
- Weightlifting of light or heavy weights causes stretching of the tendon. Repeated use of tendon resulting in frequent stretching causes inflammation of the tendon with microscopic tear and laceration of the tendon.
Infection of Hand Causing Hand Tendonitis
- Penetrating Wound– Penetrating wound of the hand causes infection of the soft tissue which includes tendon. Tendon infection causes inflammation and tendonitis. Tendonitis of the palm and finger associated with infection may not respond to anti-inflammatory medication and must be treated with antibiotics.
- Spread of Local Infection– Soft tissue infection of skin and subcutaneous tissue often spreads into deeper tissue of hands resulting in tendonitis of the palm and fingers.
- Spread of Abscess– Abscess of wrist or fingers often spreads into palm and tendon of the fingers. Spread of abscess causes infection and inflammation of the tendon resulting in tendonitis of the hand.
- Tendon Sheath Infection– Tendon sheath infection is associated with tendonitis.1
Degenerative Diseases of Hand Causing Hand Tendonitis
Degenerative disease of hand like osteoarthritis is associated with tendon degeneration and inflammation resulting in hand tendonitis.
Ischemic Changes Causing Hand Tendonitis
- Arterial thrombosis or embolism of hand causes severe ischemia (lack of oxygen) resulting in ischemic tendonitis and atrophy of the tendon.
- Ischemia also causes lack of nutrition to soft tissue like tendon and results in inflammation of tendons of the hand.
Risk Factors Causing Hand Tendonitis
- Rheumatoid Arthritis
- Penetrating Wound
- Degenerative Bone Disease
- Side Effects of Antibiotics- ciprofloxacin or levofloxacin.
Symptoms of Hand Tendonitis
Palm and Finger Pain Caused by Tendonitis
- Intensity of Pain– Mild to moderate or dull pain during early phase of the inflammation. Pain becomes severe in later phase during inflammation and becomes chronic and lasts longer.
- Duration of Pain– Continuous severe pain as long as tendon inflammation is active. Pain becomes mild and disappears once the inflammation is reduced or eliminated.
- Pain at Rest– Mild to moderate or dull pain at rest.
- Pain with Activities-Pain becomes severe with the activities of the hand and restricts the hand activities. Later during the day pain becomes moderate after use of the hand.
Severe Pain with Hand Movement
- Hand movements are painful.
- Patient avoids hand movement when requested during examination
- Prominent rope like structure of tendon is often seen during examination of the hand.
Signs of Hand Tendonitis
Tenderness on Examination
- Palpation of touch to inflamed tendon provokes severe pain.
- Tenderness is observed when pressure is applied directly over the tendon
Movements of Hand
Pain is felt along the inflamed tendon when tendon is pulled following muscle contraction.
Swelling of The Tendon
Occasionally painful swollen tendon under palm is seen suggesting tendon inflammation.
Contraction of the muscles, which is attached to tendon results in severe pain.
Signs of Trigger Finger
- Pain- Severe pain is observed when muscle attached to tendon is used or contracted.
- Swelling- Examination suggests tendon is swollen.
- Snap- Movement of the finger causes snap sound.
- Lock Finger- Finger is often locked in semi-flex position.
Investigations And Lab Studies for Hand Tendonitis
X-ray of The Palm And Fingers for Hand Tendonitis
- X-ray does not show changes caused by soft tissue inflammation.
- X-Ray is performed to rule out fracture, dislocation and inflammatory bone diseases.
MRI Study of The Hand for Hand Tendonitis
- MRI image study is performed to evaluate details of soft tissue like tendon. Changes in inflamed tendon is compared with normal tendon to diagnose the tendonitis.
- MRI is also performed like X-ray to rule out fracture, dislocation and inflammatory bone diseases.
Ultrasound Study of The Hand for Hand Tendonitis
- Ultrasound study is performed to diagnose abscess or hematoma (blood clot) within soft tissue of hand and finger.
- Ultrasound study is a Doppler study that uses high frequency sound waves.
- Different images are produced by different tissue like fluid (abscess), air and solid (bone) structure with different densities.
- Radiologist interprets images.
Blood Examination for Hand Tendonitis
Increased white blood cell count suggests infection or abscess causing pain.
Treatment of Hand Tendonitis
Conservative Treatment For Hand Tendonitis
Restriction of Hand Movement
Movement of the hand causes severe pain. Restriction of movement helps to reduce pain. Inflammation of the tendon may aggravate with continuous use of hand and tendon activities.
Use of Braces as Treatment for Hand Tendonitis
- Braces are used to restrict the hand movement during the treatment.
- Braces are used until the inflammation of tendon is reduced or healed.
- Braces also protect the inflamed tendon from further injury by direct impact.
Cold Therapy Treatment for Hand Tendonitis
- Ice pack is applied for 15 to 20 minutes 3 to 4 times a day.
- Ice pack keeps the temperature of tendon and surrounding tissue at lower temperature, which helps to reduce pain and swelling.
- Cold therapy helps to minimize tendon inflammation.
Medications for Hand Tendonitis
Non-Steroid Anti-Inflammatory Medications (NSAIDs) For Hand Tendonitis
- Prescribed for 7 to 10 days for tendon inflammation.
- Prescribed for pain over 10 days.
- Most common NSAIDs used are Motrin, Naproxen, and Celebrex.
Muscle Relaxants for Hand Tendonitis
- Prescribed for muscle spasm of forearm or hand muscles.
- Prescribed for muscle pain in forearm and hand muscles.
- Most common muscle relaxant prescribed is Baclofen, Skelaxin and Flexeril.
Opioids for Hand Tendonitis
- Prescribed for severe pain not responding to NSAIDs and muscle relaxants.
- Prescribed for short period of time 2 to 3 weeks.
- Patient is frequently evaluated for opioid dependence and addiction.
- Most common short acting opioid prescribed are hydrocodone and oxycodone.
- Most common long acting opioids prescribed is Oxycontin, MS Contin and Methadone.
Antibiotics For Hand Tendonitis
Tendon sheath infection is treated with antibiotics.1 Tendonitis associated with tendon sheath infection is often difficult to treat.
Physical Therapy (PT) For Hand Tendonitis
PT During Treatment of Tendon Inflammation-
- Physical therapy is advised to prevent muscle atrophy of forearm and hand muscles if tendonitis lasts for prolonged period.
- PT includes heat and cold therapy for chronic pain
PT Following Cure of Tendon Inflammation-
- Physical therapy is prescribed following the treatment of tendon inflammation and pain is less severe.
- PT is directed to strengthen the muscle tone and power.
Interventional Pain Therapy For Chronic Hand Tendonitis
Cortisone Injection for Hand Tendonitis
- Cortisone is injected to treat tendonitis or tendon inflammation.
- Injection is performed close to the tendon by using image intensifier.
Surgery as Treatment Choice For Hand Tendonitis
Tendon Repositioning- Surgery is performed to treat pain caused by atrophied tendon or trigger finger.2
1. Flexor tendon sheath infections of the hand.
Draeger RW1, Bynum DK Jr.
J Am Acad Orthop Surg. 2012 Jun;20(6):373-82. doi: 10.5435/JAAOS-20-06-373.
2. Practical management of tendon disorders in the hand.
Farnebo S1, Chang J.
Plast Reconstr Surg. 2013 Nov;132(5):841e-853e.