What is the treatment for wrist tendonitis?

Treatment for Wrist Tendonitis

The recommended treatment for wrist tendonitis begins with conservative management including relative rest, ice therapy, NSAIDs, and eccentric strengthening exercises for 3-6 months before considering more invasive interventions. 1

Initial Diagnosis and Assessment

• Wrist tendonitis typically presents with insidious onset of load-related localized pain that coincides with increased activity 2
• Physical examination reveals well-localized tenderness that reproduces the pain experienced during activity 2
• Ultrasound is useful for examining extra-articular soft tissues and can diagnose abnormalities of the flexor and extensor tendons and tendon sheaths 2
• MRI without IV contrast can diagnose or confirm tendinopathy, tendon tear, intersection syndrome, tenosynovitis, and stenosing tenosynovitis 2

First-Line Conservative Management

• Relative rest should be implemented to prevent ongoing damage by avoiding activities that worsen pain while maintaining some activity to prevent muscle atrophy 1
• Ice therapy provides short-term pain relief, reduces swelling, and blunts inflammatory response 1
• NSAIDs (oral or topical) effectively relieve pain in the acute phase, with naproxen 500 mg initially followed by 250 mg every 6-8 hours as recommended for acute tendonitis 3
• Topical NSAIDs are preferable due to eliminated risk of gastrointestinal hemorrhage associated with systemic NSAIDs 1
• Eccentric strengthening exercises stimulate collagen production and guide normal alignment of newly formed collagen fibers 1
• Stretching exercises are helpful for tendon rehabilitation 1
• Wrist splinting or bracing can help reinforce, unload, and protect tendons during activity 1, 4

Second-Line Treatments

• Corticosteroid injections may be more effective than NSAIDs for relief in the acute phase but do not alter long-term outcomes 1, 5
• Caution is warranted with corticosteroid injections as they may inhibit healing and reduce tensile strength of the tissue, potentially predisposing to rupture 1
• Therapeutic ultrasonography may decrease pain and increase collagen synthesis, though evidence for consistent benefit is limited 1
• Deep transverse friction massage is recommended to reduce pain in tendinopathies 2

Specific Wrist Tendinopathies

• De Quervain tenosynovitis (stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendon compartment) may require surgical management if conservative treatment fails 4
• Intersection syndrome (tendinitis or tenosynovitis in the first and second dorsal compartments of the wrist) presents with tenderness and crepitation several centimeters proximal to Lister's tubercle 6
• Extensor carpi ulnaris tendinitis and flexor carpi radialis tendinitis are common conditions that may require specific management approaches 4

Surgical Management

• Surgical evaluation is warranted if pain persists despite 3-6 months of well-managed conservative treatment 1
• Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 1
• For specific conditions like De Quervain tenosynovitis, surgical release of the first dorsal compartment may be necessary 4

Prognosis and Follow-up

• Most patients with overuse tendinopathies (about 80%) fully recover within 3-6 months with appropriate conservative treatment 1
• Technique modification for athletes and manual laborers aims to minimize repetitive stresses placed on tendons 1
• Regular follow-up is important to assess response to treatment and adjust management as needed 2

Important Considerations

• Actual inflammation of tendon tissue consistent with tendonitis has not been clearly seen in patho-anatomic studies, suggesting that the condition may be more accurately described as tendinosis (degenerative) rather than tendonitis (inflammatory) 7
• The presence of multiple symptomatic tendons should alert the physician to consider evaluation for rheumatic disease 2