Our tendons are firm connective tissue ropes or cords that connect our muscles to our bones. When our muscles contract, they pull the tendon which in turn pulls the bone, enabling us to move our joints. When the dozens of tendons in our hands and wrists become inflamed following overuse or injury, it can affect everyday activities and make simple tasks difficult or painful to perform.
What is tendonitis?
Tendonitis means “inflammation of a tendon”, which causes localized swelling and pain. The joint controlled by that tendon becomes difficult and painful to move. Tendonitis can be caused by direct injury or repetitive use. However, arthritis, hypothyroidism, hormone imbalances (menopause), water retention (pregnancy) and certain medications (cholesterol lowering, hormones) can also cause or worsen tendonitis.
What are the types of tendons in the hand and writst?
There are multiple tendons in the hand and wrist that can be impacted by tendonitis, negatively affecting your range of motion and quality of life.
Tendons in the hand
There are three types of tendons in the hand: extensor tendons, flexor tendons and intrinsic tendons.
- Extensor tendons: These tendons allow us to straighten our fingers and thumbs, and run from our forearm across the back of our hands.
- Flexor tendons: These tendons allow us to bend our fingers, and run from our forearms through our wrists, crossing the palms of our hands.
- Intrinsic tendons: These are small tendons within the hand which are responsible for dexterity and fine motor skills, such as writing and fastening buttons.
Tendons in the wrist
There are six main tendons in the wrist: our flexor carpi radialis, flexor carpi ulnaris, palmaris longus,, extensor carpi radialis brevis, extensor carpi radialis longus, and extensor carpi ulnaris.
- Flexor carpi radialis: This tendon attached to the base of our second and third hand bones, allowing us to bend our wrists. The flexor carpi radialis, along with the flexor carpi ulnaris, are responsible for helping us bend our wrists.
- Flexor carpi ulnaris: This tendon is attached to the pisiform and 5th hand bone, where the palm and outer wrist meet. With our Flexor carpi radialis tendon, this also helps us bend our wrists.
- Palmaris longus tendon: While this tendon is not frequently impacted by tendonitis, it plays a key role in surgical procedures, as it is often used in tendon repairs and transfers to treat severe cases of tendonitis. Only 75% of the population are born with this tendon, and it varies in size from person-to-person.
- Extensor carpi radialis brevis: This tendon starts in our forearm and travels to the thumb, and is attached to the base of our hand bones. It works with our extensor carpi radialis longus and extensor carpi ulnaris to help bend our wrists back.
- Extensor carpi radialis longus: This tendon starts on the thumb side of the forearm and runs down to the wrist. Along with our extensor carpi radialis brevis and extensor carpi ulnaris, it helps bend the wrist, and can be negatively impacted by tendonitis.
- Extensor carpi ulnaris: This tendon starts on the little finger side of our forearm, moving the wrist in the direction of the pinky, instead of the thumb, like our extensor carpi radialis brevis and extensor carpi radialis longus.
What are the causes of tendonitis?
Tendonitis is traditionally caused by the following:
- Acute injuries: The impact from a car accident, fall or other blunt trauma can cause tendonitis. If the impact is strong enough, the injured tendon may tear or rupture completely. If untreated, tendonitis can worsen over time.
- Repetitive injuries: Playing sports or performing other repetitive activities such as typing, assembling or lifting, can cause tendons to become inflamed and painful. . These symptoms usually develop gradually and worsen over time.
- Age-related changes in the tendon: As we age, our tendons lose their ability to bear weight and heal. This makes older tendons more prone to injury, scar formation and chronic tendonitis.
- Carpal tunnel syndrome: When the nerve becomes compressed in the carpal tunnel of the wrist, tendonitis of the adjacent tendons can occur.
- Arthritis: When arthritis symptoms flare up, the joints become inflamed. Joint inflammation can, in turn, cause inflammation of the nearby tendons as well.
What are the symptoms of tendonitis?
Common symptoms of hand and wrist tendonitis include the following:
- Swelling: Because tendonitis results in inflammation of the affected tendon and surrounding tissue, the hand wrist and forearm can swell.
- Stiffness: Tendonitis can cause mild to moderate stiffness of the affected tendon and the joint it controls. This may cause reduced range of motion in the hand and/or wrist.
Pain with movement: opening and closing the hand or bending and rotating the wrist may be painful. - Reduced strength: During or after lifting weights or other forms of physical work, a feeling of weakness or reduced grip strength may be experienced in the hand, wrist or forearm.
- Trigger finger: When the flexor tendons of the fingers become inflamed, they no longer glide smoothly and can get stuck. When this occurs, the finger itself can click, catch or become stuck in a bent position.
If you’re experiencing these symptoms as a result of trauma from an accident, repetitive use, nerve damage and/or ligament injury, we recommend seeking medical care from a Board Certified hand and wrist orthopedic specialist.
How is tendonitis diagnosed?
When you visit a specialist for help with your tendonitis symptoms, they’ll first ask you about any preexisting conditions, previous injuries and family history of tendonitis and other inflammatory conditions.
Tendonitis can usually be diagnosed by a physical exam, but your orthopedic specialist may also order X-rays and other imaging tests such as MRI to rule out other conditions — like arthritis or bursitis — and to assess the severity of the condition.
How do you treat tendonitis in the hand?
Nonsurgical treatment
While the majority of tendonitis symptoms will resolve on their own, your orthopedic specialist will likely recommend:
- Rest and limiting movement to prevent aggravation.
- Wearing a split throughout the day and occasionally at night to rest the tendon, provide support for the joint, prevent further tendon irritation. and promote recovery.
- Nonsteroidal anti-inflammatory medication (NSAIDs) — whether prescribed or over-the-counter—to help relieve pain, discomfort, inflammation, and swelling.
- Interchanging ice and heat to provide relief from pain and inflammation.
- Corticosteroid injections to reduce swelling and pain
- Physical therapy
Surgical treatment
If your symptoms persist or if your tendonitis becomes severe, your doctor will likely perform outpatient surgery to resolve the tendonitis and to prevent recurrence. This is often performed under local anesthetic.
During the surgical procedure to treat tendonitis, the surgeon will make small incisions over the inflamed tendons, removing scar tissue, releasing constrictive bands, and restoring normal tendon gliding. The surgery is minimally invasive and often results in the return of normal tendon function and strength
Our Alexander Orthopaedics Outpatient Advantage bypasses the need for a lengthy hospital stay, ensuring that you will return home the day of your procedure.
How long does it take to recover from tendonitis surgery?
Depending on the severity and location of tendonitis, recovering from tendonitis surgery may take as little as two weeks, , but it could take three months or longer to regain full mobility. Your orthopedic surgeon may require you to wear a splint after surgery to protect the repaired tendon and to help avoid reinjury.
When you attend physical therapy, you will learn a number of different exercises to strengthen the affected area, regain full motion and prevent reinjury.
What is post-operative pain like?
Patients may experience pain at the incision site, as well as lingering stiffness and soreness when trying to move the affected area for a few days to a couple of week, depending on the location of the surgery and the extent of repair required.
To reduce swelling and pain, you should elevate the affected area and take pain medication and anti-inflammatory medication for a few days to a couple of weeks. Patients can resume light to medium activities like typing or writing by hand within a few days after surgery, but it could take 8 to 12 weeks to resume more strenuous activities like sports or weight lifting.
What happens if tendonitis goes untreated?
It is important to seek treatment when you begin to experience symptoms of tendonitis. If left untreated, you could experience a complete rupture of the tendon, or develop chronic tendonosis, a condition which causes the gradual degeneration of the tendon over time, leading to increased discomfort, swelling, tearing , weakness and lumps along the affected tendon.
Get expert tendonitis treatment with Alexander Orthopaedics
From diagnosis to treatment — whether surgical or non-surgical — our hand and wrist experts at Alexander Orthopaedics will design a personalized treatment plan to help minimize your tendonitis symptoms and put you on the road to recovery, faster.