How to treat wrist tenosynovitis and sprain?

Treatment of Wrist Tenosynovitis and Sprain

The most effective treatment for wrist tenosynovitis and sprain includes relative rest, analgesics such as acetaminophen, eccentric strengthening exercises, and functional support, while avoiding immobilization that could worsen the condition. 1

Initial Assessment and Diagnosis

• Radiography is recommended as the initial imaging study to rule out fractures or arthritic changes 2
• Ultrasound is highly appropriate for evaluating tendon injuries, tenosynovitis, or tendon pathology due to its:
  • Ability to dynamically assess tendons
  • High specificity (94%) for detecting tendon thickening and tears 2, 1
• MRI without IV contrast is indicated if symptoms persist after initial treatment 2

Treatment Algorithm

First-Line Treatment (0-4 weeks)

1. Relative Rest

   • Reduce activities that cause pain and overload the affected tendon
   • Avoid complete immobilization as it may worsen the condition 1

2. Pain Management

   • Acetaminophen (up to 4g/day) as first-line analgesic
   • NSAIDs at lowest effective dose for shortest duration if acetaminophen is inadequate
   • Consider topical NSAIDs for localized pain with fewer systemic side effects 1

3. Functional Support

   • Use a brace rather than immobilization
   • Choice should be based on patient preferences 2

4. Exercise Therapy

   • Begin eccentric strengthening exercises as soon as possible
   • Start gradually and progress in intensity and volume
   • Continue for at least 12 weeks for optimal results 1

Second-Line Treatment (if no improvement after 4-6 weeks)

1. Consider local corticosteroid injection for short-term relief in the acute phase 1
2. Physical Modalities
   • Laser therapy and therapeutic ultrasound are effective for tenosynovitis 3
   • Extracorporeal shock wave therapy (ESWT) has shown efficacy for certain types of tenosynovitis 3

Third-Line Treatment

1. Surgical intervention should only be considered when:
   • Conservative treatments fail after adequate trial
   • For patients requiring quick recovery (e.g., professional athletes)
   • To prevent tendon rupture in high-risk patients (e.g., those with rheumatoid arthritis) 2, 4

Special Considerations

• Rheumatoid arthritis patients may require early surgical intervention to prevent tendon rupture 1
• Diabetic patients tend to respond less to conservative measures and may require modified treatment approaches 1
• Multiple symptomatic tendons should alert to the possibility of underlying rheumatic disease 1

Prognosis

• Approximately 80% of patients recover completely within 3-6 months with conservative treatment 1
• Evaluate pain and function every 2-4 weeks
• Progress to activity-specific exercises as symptoms improve

Common Pitfalls to Avoid

1. Avoid RICE protocol (Rest, Ice, Compression, Elevation) as it is not recommended for sprains 2
2. Avoid prolonged immobilization as it can worsen the condition and delay recovery 2, 1
3. Don't delay exercise therapy - it should be started as soon as possible to recover joint functionality 2
4. Don't overlook underlying conditions that may contribute to tenosynovitis (e.g., rheumatoid arthritis, diabetes)

The evidence strongly supports a conservative approach focused on functional support, appropriate pain management, and early exercise therapy for most cases of wrist tenosynovitis and sprain, with more invasive interventions reserved for refractory cases.