Treatment Plan for Flexor Carpi Radialis Tendinosis in the Right Wrist
The recommended initial treatment for flexor carpi radialis tendinosis should focus on conservative management including relative rest, cryotherapy, and eccentric strengthening exercises for 3-6 months before considering more invasive interventions. 1
Initial Conservative Management
- Implement relative rest to decrease repetitive loading on the damaged tendon while avoiding complete immobilization that could lead to muscular atrophy 1, 2
- Apply cryotherapy (ice through a wet towel for 10-minute periods) for short-term pain relief 2, 3
- Prescribe NSAIDs for short-term pain relief, recognizing they don't affect long-term outcomes 1, 3
- Consider topical NSAIDs as an alternative with fewer systemic side effects 2, 3
- Initiate eccentric strengthening exercises which have proven beneficial in tendinosis and may reverse degenerative changes 1, 3
- Recommend deep transverse friction massage to reduce pain 2, 3
Orthotic Support
- Consider wrist bracing or orthotics to reinforce, unload, and protect the tendon during activity 1
- While limited data support definitive conclusions on orthotic effectiveness, they are safe and may help correct biomechanical issues 1
Advanced Interventions (if conservative treatment fails)
- Consider corticosteroid injections for better acute pain relief than oral NSAIDs, but use with caution as they may inhibit healing and reduce tensile strength 1, 3
- Therapeutic ultrasonography may be beneficial, though evidence for consistent benefit is limited 1
- Extracorporeal shock wave therapy (ESWT) is a safe, noninvasive option for chronic tendinopathies 2, 3
Surgical Considerations
- If symptoms persist after 3-6 months of appropriate conservative management, surgical consultation is warranted 1, 3
- The degree of tendon rupture should guide surgical approach - MRI can help determine the extent of involvement 4
- For <50% tendon rupture, tenosynovectomy and excision of any osteophytes may be performed 4
- For >50% tendon rupture, an FCR-sacrificing procedure may be necessary 4
- Surgical tenolysis (opening the osteofibrous tunnel) has shown success in cases where non-operative treatment fails 5
Monitoring and Follow-up
- Monitor pain levels and functional improvement during conservative treatment 2
- Assess for complete relief of symptoms and ability to return to previous levels of activity 4
- Be aware that FCR tendinitis most commonly affects the distal aspect of the tendon where it lies in a tight fibro-osseous tunnel 6
Pitfalls and Considerations
- Avoid complete immobilization to prevent muscular atrophy and deconditioning 2, 3
- Rule out other potential causes of radial wrist pain, such as osteoarthritis of the scaphoid-trapezium joint which can compress the tendon 7
- Consider the possibility of concomitant flexor carpi radialis brevis tendinopathy, which can contribute to radial wrist pain 8
- Most patients with overuse tendinopathies (about 80%) fully recover within 3-6 months with appropriate outpatient treatment 1