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    Move Forward Guide

    Physical Therapist's Guide to Wrist Tendinitis

    Wrist tendinitis is a condition that most commonly occurs in individuals who perform repetitive activities using the hand and arm. These include computer users, factory workers, and athletes who throw and catch balls and play racquet sports. In the United States, the incidence of tendinitis as an occupational injury in people who work full time is 1.1 per 100,000. Overuse tendinitis is responsible for 25% to 50% of all sports injuries in the United States. Older individuals are often more at risk for wrist tendinitis due to a loss of elasticity in the wrist tendons. Physical therapists help people with wrist tendinitis reduce their pain, increase their wrist flexibility and strength, and return to their previous functional activities and sports.


     

    What is Wrist Tendinitis?

    Wrist tendinitis is a condition where 1 or more tendons in the wrist become inflamed and irritated. There are several tendons in the wrist that connect the muscles of the forearm and hand to the bones of the wrist and hand. These tendons are the small rope-like structures that you can see connecting to the fingers on the back of your hand. There are a number of conditions that can affect the tendons in this area.

    • Wrist tendinitis applies to the early stages of tendon inflammation and irritation.
    • Tendinopathy is the name given to the condition when it persists over time, is not treated, and becomes chronic.
    • Tenosynovitis is the term given to an irritation that develops when the synovial sheath (through which some of these tendons glide) thickens and restricts the tendon.
    • De Quervain's Tendinitis applies to tendinitis that develops on the thumb side of the wrist.
     

    How Does it Feel?

    Several tendons in the wrist can become irritated with wrist tendinitis. Pain symptoms associated with the condition include:

    • Pain where the arm meets the hand, which can radiate up into the elbow.
    • Pain on the thumb side of the wrist (radial) or the little-finger side of the wrist (ulnar).
    • Pain that only occurs when the wrist is under strain, which can become constant pain when left untreated.
    • Pain when putting pressure on the hand, such as using the arms to push yourself up out of a chair to stand.

    Besides pain, other symptoms include:

    • Stiffness of the wrist, and a decreased ability to bend and extend the wrist.
    • Inflammation or swelling in the wrist area.
    • Tenderness to touch in the wrist and/or forearm muscles.
     

    How Is It Diagnosed?

    Your physical therapist will conduct a thorough evaluation of your entire arm to include the shoulder, elbow, wrist, and hand. The therapist will ask you to describe the types of activities you normally perform using your arm at home, at work, and for recreation, and which of these activities causes pain or stiffness in the area. You will be asked how long the pain has been occurring and how it is affecting your regular activities of daily living. Your physical therapist will check your range of motion and strength in your entire upper arm. Your therapist will gently touch specific areas of your wrist and forearm to determine which wrist tendons are involved, and check for any swelling in the area.

     

    How Can a Physical Therapist Help?

    Physical therapy is a highly effective treatment for wrist tendinitis. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

    Pain Management. Your physical therapist will help you identify and avoid painful movements, and show you how to correct abnormal postures to reduce stress on the wrist. Your therapist may recommend resting the wrist short-term, and applying ice to the area to help alleviate pain. Your physical therapist also may apply a wrist brace to restrict wrist movement, allowing the tendons to heal.

    Manual Therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and wrist stretches to get your wrist moving properly.

    Range-of-Motion Exercises. You will learn exercises and stretches to reduce stiffness and help your wrist, hand, and forearm begin to move properly.

    Strengthening Exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific areas of weakness. The entire arm, including the shoulder, elbow, and wrist, can potentially be weakened and contribute to the movement dysfunction that causes tendinitis. Your physical therapist will design an individualized home-exercise program to meet your specific needs and goals, which you can continue long after you have completed your formal physical therapy.

    Patient Education. Depending on the specific activities you plan on resuming, your physical therapist will teach you ways to perform actions, while protecting your wrist and hand. For example, keeping the wrist in a neutral position to reduce excessive force while performing repetitive tasks, and taking frequent breaks are ways to decrease your chances of reinjury.

    Functional Training. As your symptoms improve, your physical therapist will teach you how to correctly perform functional movement patterns using proper wrist mechanics, such as typing on a computer or swinging a racquet. This training will help you return to pain-free function on the job, at home, and when playing sports.

     

    Can this Injury or Condition be Prevented?

    To prevent wrist tendinitis, physical therapists recommend that you:

    • Avoid repetitive wrist and hand movements.
    • Warm up the muscles around the wrist and hand before starting an activity.
    • Perform regular stretches to maintain flexibility in the wrist and forearm before and after exercise or activity.
    • Perform regular upper-body strengthening exercises to enable the wrist and hand to tolerate sports and other activities of daily living, with less stress to the joint.
    • Follow joint protection techniques when using the wrist, such as balancing rest with work, and using the larger muscles of the arm for heavier tasks.
    • Do not continue an activity that is painful or uncomfortable to the wrist and hand.
     

    Real Life Experiences

    Jennifer is a 50-year-old woman who works in a busy office. She spends most of her day entering data on a computer. Her office just purchased new laptops with track pads. After a few weeks of using the new computer, Jennifer began to feel stiffness in her right wrist after her 8-hour shift.

    This past week, the stiffness has developed into pain. At first, the pain started when Jennifer left work, but now she is having constant pain and stiffness along the little finger side of her wrist that is making her computer work much more difficult.

    Jennifer also likes to exercise and stay active and healthy. She has heard that sitting all day at a desk isn’t good for her back or overall fitness level, so she has started taking yoga classes after work at a local studio. However, some of the yoga positions require her to bear weight through her hands and wrist. This week, it has become really painful to perform her yoga poses, especially the poses that require her to bear weight through her hands. She decides to see her physical therapist.

    Jennifer's physical therapist performs a comprehensive evaluation on her entire right wrist, hand, elbow, and shoulder. He asks several questions regarding Jennifer’s normal daily tasks and her recreational activities. He presses gently on certain tendons around Jennifer’s right wrist and finds they are tender to touch in several areas. He also determines that Jennifer has reduced flexibility and strength in the right wrist and hand. He tells her that she has developed wrist tendinitis.

    Jennifer's treatment begins with gentle range-of-motion exercises. Her physical therapist applies ice to the area to relieve her pain, and shows her how to repeat it at home. He applies a wrist splint and instructs Jennifer to wear it for a few weeks to allow the tendons to heal. He shows her how to take the splint off to perform gentle range-of-motion exercises at home.

    Jennifer's physical therapist watches how she positions her wrist during several tasks, and suggests she use a computer mouse instead of the track pad on her laptop at work. He teaches her how to maintain a neutral wrist position when performing her computer tasks, and gives her tips on how to maintain an ideal posture at her computer workstation.

    Jennifer demonstrates some of the yoga poses that are uncomfortable for her. Her physical therapist observes that she is bearing weight incorrectly through her wrists during these poses, putting undue pressure on her bones and tendons. Together they work on modifying her poses to avoid wrist pressure altogether, and allow healing.

    After a few weeks of diligent physical therapy sessions, Jennifer’s pain alleviates. She can now get through a full work day and perform yoga without any pain or limitation. She continues to perform a home-exercise program to keep her wrist strong and flexible. She follows the posture and joint-protection techniques she learned during her physical therapy sessions.

    Jennifer is pleased to note that her productivity at work has actually increased, as she focuses on proper posture and positioning at her workstation, and remembers to take frequent breaks from the computer. She now feels that she maintains a much healthier lifestyle—including her weekly pain-free yoga sessions, where she has proudly advanced from the beginner to the intermediate level!

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat wrist tendinitis. However, you may want to consider:

    • A physical therapist who is experienced in treating people with wrist and hand diagnoses. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
    • A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedics or sports physical therapy, or is a hand specialist. These therapists have advanced knowledge, experience, and skills that may apply to your condition.

    You can find physical therapists who have these and other credentials by using  Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapist's' experience in helping people who have wrist tendinitis.
    • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence for the treatment of wrist tendinitis. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    Campbell D, Campbell R, O’Connor P, Hawkes R. Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management. Br J Sports Med. 2013;47(17):1105–1111. Free Article.

    National Center for Biotechnology Information. National Library of Medicine. June 6, 2013. West, and G David Baxteris

    Scott A, Docking S, Vicenzino B, et al. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012 [erratum in: Br J Sports Med. 2013;47(12):744]. Br J Sports Med. 2013;47(9):536–544. Free Article.

    Kaux JF, Forthomme B, Le Goff C, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med. 2011;10(2):238-253. Free Article.

    Woodley BL, Newsham-West RJ, Baxter GD. Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med. 2007;41(4):188–198. Free Article.

    Woodley BL, Newsham RJ; US Department of Labor. Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers for selected characteristics and industry division, United States, 2002. . Published April 28, 2004.

    Biundo JJ Jr, Irwin RW, Umpierre E. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 2001;13(2):146–149. Article Summary in PubMed.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored by Julie A. Mulcahy, PT, MPT. Reviewed by the MoveForwardPT.com editorial board.