WRIST TENDINOPATHY
 
Wrist tendinopathy
What is it?
Wrist tendinopathy usually affects the extensor tendons and the compartments of the wrist that they fit through. There are in fact 6 separate compartments on the back (dorsum) of the wrist that contain tendons of muscles that extend (as opposed to flex) the wrist and the fingers and thumb.

These extensor tendons are held in place inside their compartment by the extensor retinaculum, a strong transverse ligament that the tendons pass under. The tendons themselves are wrapped in a synovial tendon sheath that protects them from rubbing against each other in such a tight space.

The compartments are numbered with each compartment containing specific extensor tendons. If you have a problems with wrist tendinopathy this means either specific tendons have become strained or inflamed in their compartment or that the retinaculum ligament has become stretched or damaged. Either way the wrist is painful and unstable or weak secondary to this pain.
Wrist tendinopathy
Types of conditions associated with the Extensor compartments
De-Quervain's tendonitis
The most common condition seen in the extensor compartment affects the 1st dorsal compartment. Here the thumb tendons are injured and this condition is called De-Quervain's disease or thumb tendonitis.

ECU tendonitis
The second most common condition is ECU tendonitis (extensor carpi ulnaris) which is in the 6th dorsal compartment. It is seen in rowing and racket sports and is quite common in the non-dominant wrist of tennis players caused by the two-handed backhand.

Biomechanical studies have shown that the wrist is deviated towards the little finger (ulnar deviation) for most racket sports. The non-dominant wrist is in even more ulnar deviation during the two-handed stroke. This stresses the ECU tendon. 

ECU tendonitis may also be the result of underlying ulnar wrist pathology such as TFCC injury or wrist fracture.

Wrist tendinopathy
4th Dorsal compartment syndrome
This affects the tendons of extensor digitorum communis (EDC) and extensor indicis (EI). Together they are responsible for extending the fingers at the knuckle joints.

Causes:
  • Doing activities that require repeatedly extending all the fingers and wrist such as typing on a keyboard or using a touch screen with a pointed finger
  • Stationary positions such as using a mouse for long periods with the wrist and fingers extended on it causing fatigue. Resting the hand on a mouse out of habit even when not in use put unnecessary pressure on the wrist tendons
  • Strong flexion of the wrist which over stretches the extensor tendons causing micro tears in the sheath
  • Overuse of extensor muscles which causes irritation to the dorsal compartment over time leading to irritation and inflammation of the extensor retinaculum
Wrist tendinopathy
Intersection syndrome
Intersection syndrome is tenosynovitis, swelling of the sheaths surrounding the tendons in the 2nd dorsal compartment. 
These tendons are called extensor carpi radialis longus (ECRL), and extensor carpi radialis brevis (ECRB) and they extend the wrist on the radial side (lifting the wrist favouring the thumb side).  Intersection syndrome means these tendons rub against each other when they contract during movement leading to inflammation.

It is very close to the site of de-Quervain's tendonitis in the 1st Dorsal compartment yet the treatment for each is very different. An examination by a Hand therapist will help to distinguish between the two and treat appropriately.

It is most often seen in tennis players, rowers, electricians and mechanics due to repeatedly flexing and extending the wrist towards the thumb. 
Wrist tendinopathy
Treatment at Hand Kinetics
Like most conditions caused by repetitive motion the symptoms will improve with rest, ice, compression and elevation. (R.I.C.E)

Rest: The tendons need rest to allow healing to take place. Tendon fibres that are injured need to stay still as newly healing fibres are fragile. A wrist splint will allow you to keep active while preventing movement in the affected tendons. 

Ice: Put an ice pack on the injury for up to 20 minutes every 2 to 3 hours to reduce swelling (you could use a bag of frozen peas wrapped in a tea-towel).

Compression: Use a sports wrist support to help reduce swelling. Learn from your Hand therapist how to apply sports tape to target the swelling in the local area. This is very popular and is easy to wear.

Elevate: Take an opportunity to raise the arm above your head as often as you can.

Wrist tendinopathy
Early treatment can prevent extensor compartment syndrome from becoming a chronic problem.

At Hand Kinetics you can expect an examination of the thumb, hand and wrist to check if other conditions are impeding repair and which actions caused it in the first place. Understanding the movements leading to the condition will be very helpful for you to avoid recurrence.

Treatment will involve wearing a thumb or wrist splint continuously for 6 weeks with a gradual introduction of exercises to build up strength in the tendons.

Massage and therapeutic ultrasound can be used to help speed up healing and remodelling of the tendon fibres. 

If you require it, we can organise an ultrasound scan at the Mourne scan clinic to confirm the diagnosis and recommend the treatment most likely to help you to recover. This will take into account how long you have had your symptoms and which treatments you may have already tried.

Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com



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