Wrist Tendonitis: What You Need to Know

Tendonitis occurs when tendons become inflamed. Tendons, also referred to as sinew, are “thick fibrous cords that attach muscle to bone” (1). Tendons function as the “mechanical bridges” between the strength of muscles and bones or joints and enable muscle contractions (2).

Tendonitis physiologically results from tendons crossing over each other or from the crossing of bones. This crossing can cause both microtears and macrotears:

• Microtears are small soft tissue tears in or near tendons (3). 
• Macro tears involve significant damage to a part of the tendon or the whole tendon.

Wrist tendonitis may also be referred to as De Quervain's Tendonitis or Dr. Quervain’s Tenosynovitis (4, 5). However, tendonitis should not be confused with tendonosis, which is a condition that occurs when collagen in the tendon degenerates (6).

Tendons play an important role in bodily movement and activity. Perhaps unsurprisingly, tendonitis often occurs in athletes. In fact, tendon overuse accounts for 30-50% of sports injuries (7). Athletes who perform repetitive motions, like baseball pitchers and golfers, are especially prone to tendonitis (8).

Wrist tendonitis often results from basic repetitive actions such as writing or typing. Twisting the wrist, like when using a screwdriver, can also cause tendonitis. People who knit, play video games, and perform other activities with regular, repetitive hand motions can suffer from tendonitis. Some new mothers experience tendonitis from lifting their babies (9).

Far less common than tendonitis caused by repetitive movement is tendonitis that results from an impromptu injury (10). This may happen if someone engages in intense exercise for the first time in a long time or returns to playing a sport too soon following an injury. Infrequently, infections from animal bites, gonorrhea, or gout can also cause tendonitis (11, 12).

Tendonitis is more common later in life as the tendons begin to lose their flexibility. People who suffer from arthritis or diabetes may experience tendonitis as well, though it’s important to note that tendonitis and arthritis of the wrists are not the same conditions.

People who suffer from tendonitis may notice redness or swelling near the affected tendon or tendons. A grinding sensation or a feeling as though something is “catching” during wrist or finger movement can also be signs of wrist tendonitis. Wrist pain and stiffness, especially near the base of the thumb and the side of the wrist, often arise for people suffering from tendonitis. If the tendonitis results from infection, patients may also notice a rash or have a fever (13).

A doctor will examine you to determine whether you have tendonitis, including checking the painful area for redness, swelling, or muscle weakness. They may also ask you to perform certain motions in order to determine which tendon or tendons are inflamed. Understanding your personal health history and family health history may also help your doctor form a diagnosis.

Try to describe your pain as specifically as possible to a doctor. Does the pain feel sharp or dull? Does it radiate or stay in one place? Does any muscle weakness, tingling, or numbness accompany your wrist pain? When do you notice the pain, stiffness, or other symptoms occurring – such as after exercising, when typing, or while knitting? Does anything provide pain relief? These details will help your doctor narrow down the possible conditions and guide towards a diagnosis and treatment plan.

In some cases, your doctor may order imaging to get a closer look at the bones, muscles, and tendons in the area where you’re experiencing pain. X-ray, sonography, and MRI can all be used to better understand the source of your pain. If your doctor suspects that an infection could be the cause of your tendonitis, they may require blood tests prior to formulating a diagnosis.

It’s important that your doctor accurately distinguishes between tendonitis, arthritis in the wrist, carpal tunnel syndrome, and tendonisis, as these conditions have different causes and require different treatment plans. Ask your doctor what methods they plan to use – such as physical exams, imaging, and blood tests—to determine which condition may be the cause of your wrist pain.

Splints (also called wrist braces) can provide pain relief to people who suffer from wrist tendonitis. Studies show that people who wear splints just when they want to experience similar therapeutic effects to people who wear splints continuously (14). Wrist splints are available without prescriptions in pharmacies and online. Some patients with wrist tendonitis find that simple bandage wraps provide pain relief. Others prefer wrist braces made of flexible fabric. Additional options include flexible wrist splints with removable aluminum stays and rigid plastic wrist braces.

For athletes, outdoor workers, or others who may benefit from lightweight, more comfortable splints, physical therapist or occupational therapists may prescribe a custom brace. Some patients only wear wrist splints at night and still experience positive therapeutic effects. The wrist splint will somewhat limit your range of motion, so consider if nighttime wear might be the most effective treatment plan for you. If you aren’t sure which style of splint or bracing schedule would work best for you, consult your healthcare provider.

Ice therapy may also provide pain relief and help reduce swelling. Some doctors suggest applying ice to the painful area for 15 to 20 minutes every four to six hours in order to reduce inflammation of the tendon. You can purchase ice packs at the grocery store, a pharmacy, or online, or simply fill a sandwich bag with ice cubes, wrap it in a towel, and apply it to the painful area. After a few days of ice therapy, you may want to try heat therapy by applying a heating pad to your wrist (15). 

Physical therapy – specifically deep friction therapy – is useful in tendonitis for creating scar tissue (16). Occupational therapy that combines several conservative care approaches including splints, manual therapy, and lifestyle and behavior modifications has also been shown to reduce wrist tendonitis pain (17). 

Stretching exercises for the hands may offer pain relief as well. This is especially the case just after an episode of tendonitis pain, as therapeutic stretches will promote the creation of scar tissue and help prevent recurrence. Exercises should be performed regularly in order to produce optimal effects.

Some helpful exercises include the following: 

• Stretch the thumb across the palm then stretch it out to spread all five fingers wide.
• Rotate your forearms by resting your upper arm along your side. Bend your elbow 90 degrees then rotate your forearm so that your palm changes directions.  
• Support your forearm on your thigh with your wrist extending past your knee. Outstretch your fingers in a relaxed fashion with your thumb facing upward. Move your wrist up and down, as far as is comfortable in both directions (18).
  

Topical non-steroidal anti-inflammatory drugs (NSAIDs), including topical indomethacin spray, relieve tendonitis pain with only small side effects like minor local skin irritation (19). However, NSAIDs seem to be better suited for short-term pain management than for long-term relief (20).

In addition to over-the-counter NSAIDs like ibuprofen and naproxen sodium, acetaminophen may provide some pain relief (21).

Patients who fail to find pain relief through splints, ice, heat, therapy, stretches, or over-the-counter medications may find that cortisone injections alleviate their pain temporarily (22). Less common courses of treatment like tropisetron injections and insulin-like growth factor injections also show therapeutic effects for inflamed tendons (23, 24).

While non-surgical treatment is recommended whenever possible, some patients who do not respond to less-invasive treatments may find pain relief through surgery (25). Your doctor may recommend ice therapy after surgery to optimize your recovery (26).

As with any medications, the drugs used to treat wrist tendonitis carry risks and side effects which you should consider with your doctor. Some patients taking NSAIDs experience stomach pain and heartburn (27). Acetaminophen can damage the liver and cause skin rashes (28). Steroid injections carry side effects including acne, pain at the injection site, and bleeding (29). Risks with surgery include reactions to anesthesia and infection.

If your healthcare provider determines that you have tendonitis, you have a range of treatment options at your disposal. Simple remedies like splints, icing, and over-the-counter pain relievers are relatively inexpensive and accessible. In more severe cases, a conversation with your doctor about stronger prescription medications, injections, or surgery may be necessary. These severe cases are rare, though. Tendonitis often responds well to treatment such as bracing, ice therapy, and stretching.

While you may be tempted to diagnose and treat your wrist pain as tendonitis yourself, it’s important that you get a diagnosis from a health care provider. Tendonitis shares common symptoms with several other conditions, each of which will respond best to a different treatment plan. Provide your health care provider with as much information about your symptoms as possible and ask them about the possible diagnoses and treatment plans, as well as simple methods for pain relief you can try on your own.

Behavioral changes – such as less time spent typing, writing, or crocheting – can help prevent tendonitis from recurring. Modifying your physical activity and exercise habits may help as well. Talk to your health care provider about your daily routines, time spent on the computer, and other activities. They may be able to help you find lifestyle adjustments that will reduce your pain or the chance of your tendonitis worsening or recurring.