From the Guidelines
Tendinosis of the wrist is a degenerative condition that should be treated with rest, physical therapy, and pain management, prioritizing rehabilitation to prevent recurrence and promote healing, as suggested by the most recent evidence 1.
Symptoms and Treatment Options
Tendinosis of the wrist is characterized by pain, swelling, and reduced function due to overuse, affecting the tendons in the wrist. The symptoms and treatment options for tendinosis of the wrist include:
- Pain and swelling in the wrist
- Reduced function and mobility
- Treatment typically begins with rest, avoiding aggravating activities, and using a wrist brace or splint for support
- Anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (250-500mg twice daily with food) can help manage pain and inflammation for 1-2 weeks
- Apply ice to the affected area for 15-20 minutes several times daily to reduce swelling
- Physical therapy exercises focusing on gentle stretching and strengthening are crucial for recovery
- For persistent cases, corticosteroid injections may provide temporary relief, though they're typically limited to 2-3 injections per year
Rehabilitation and Prevention
Recovery typically takes 6-12 weeks with consistent treatment, and gradual return to activities is important to prevent recurrence. Proper rehabilitation is essential to prevent further degeneration of tendon tissue and promote healing.
- Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes, as suggested by 1.
- NSAIDs are recommended for short-term pain relief but have no effect on long-term outcomes, as stated in 1.
- Topical NSAIDs are effective and may have fewer systemic side effects, as mentioned in 1.
- Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy, as indicated by 1.
Imaging and Diagnosis
Imaging studies such as plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear, as suggested by 1.
- Wrist radiographs are indicated as the best initial imaging examination in patients with chronic wrist pain, as recommended by 1.
- When radiographs are normal or equivocal and a patient has persistent symptoms with an unclear diagnosis, MRI without IV contrast is usually appropriate, as stated in 1.
From the Research
Symptoms of Tendinosis of the Wrist
- Tendinosis of the wrist is characterized by pain and discomfort in the wrist and thumb area, as seen in a case study of a 49-year-old female warehouse worker and recreational cyclist with De Quervain's tenosynovitis/tendinopathy 2
- The condition can be debilitating and affect daily activities, with symptoms including wrist and thumb pain, especially with movement or activity
Treatment Options for Tendinosis of the Wrist
- Conservative treatment options for tendinosis of the wrist include:
- Eccentric exercise-based physical therapy, which has been shown to be effective in treating tendinopathy 3, 4
- Ultrasound therapy, which has been found to be effective in treating De Quervain's tenosynovitis 5
- Low-level laser therapy, which has been studied as a treatment for De Quervain's tenosynovitis 5
- Extracorporeal shock wave therapy (ESWT), which has been found to be effective in treating Dupuytren's disease and trigger finger 5
- Medications such as NSAIDs and corticosteroid injections may be used to manage pain and inflammation, but their effectiveness in treating tendinosis is limited 3, 6
- Alternative injections, such as platelet-rich plasma (PRP) injections, have shown promise in treating tendinosis, but more research is needed to fully understand their effectiveness 3, 4
Non-Operative Treatment of Tendinosis
- Non-operative treatment of tendinosis includes a range of physical modalities, such as ultrasound, laser, and shock wave therapy, as well as eccentric exercise and other forms of physical therapy 4, 5
- The optimal non-operative treatment for tendinosis is not clear, and more research is needed to determine the most effective treatment options 4