Can repetitive ice cream scooping cause tendinitis in the 3rd compartment of the wrist?

Can Repetitive Ice Cream Scooping Cause 3rd Compartment Wrist Tendinitis?

Yes, repetitive ice cream scooping can absolutely cause tendinitis in the 3rd dorsal compartment of the wrist, which contains the extensor pollicis longus tendon. This is a classic overuse tendinopathy resulting from repetitive wrist extension and radial deviation movements required for scooping hard ice cream 1, 2.

Mechanism of Injury

The 3rd dorsal compartment houses the extensor pollicis longus tendon, which is particularly vulnerable to overuse injury due to:

• Repetitive mechanical loading from the forceful wrist extension and thumb extension required to scoop hard ice cream 1, 3
• Shear stress at the tendon as it courses around Lister's tubercle on the dorsal wrist 3
• Relative hypovascularity in the region proximal to tendon insertion, which predisposes to degenerative changes 1

Activities requiring repetitive wrist extension are well-documented causes of wrist tendinopathies, and ice cream scooping fits this pattern perfectly 1, 4.

Clinical Presentation

You should look for the symptomatic triad on examination 4:

• Pain on palpation over the 3rd dorsal compartment (just ulnar to Lister's tubercle)
• Pain with passive stretch of the extensor pollicis longus (passive thumb flexion with wrist flexion)
• Pain with resisted active contraction (resisted thumb extension)

The pain typically increases with activity and improves with rest, which is characteristic of load-related tendinopathy 1.

Treatment Algorithm

First-Line Conservative Management (3-6 months)

Implement all of the following simultaneously 1, 5:

• Relative rest: Avoid ice cream scooping and other activities that reproduce pain, but maintain some wrist activity to prevent muscle atrophy 1, 5
• Ice therapy: Apply ice through a wet towel for 10-minute periods multiple times daily for acute pain relief 1, 5
• NSAIDs: Use topical NSAIDs preferentially to avoid gastrointestinal side effects, or oral NSAIDs for short-term pain relief 1, 5
• Eccentric strengthening exercises: Begin after acute pain subsides (typically 2-3 weeks), performing 2-3 non-consecutive days per week, starting with 1 set of 10-15 repetitions and progressing to 3 sets 6
• Splinting: Consider wrist splint to immobilize and protect the tendon during the acute phase 7, 2

Second-Line Treatments (if inadequate response after 6-8 weeks)

• Corticosteroid injection: May provide better acute pain relief than NSAIDs, but use with caution as it does not alter long-term outcomes and may weaken tendon tissue 1, 5
• Physical therapy: Deep transverse friction massage can reduce pain when combined with eccentric exercises 5

Surgical Referral

Refer to orthopedic surgery if pain persists despite 3-6 months of well-managed conservative treatment 1, 5. Surgery typically involves excision of abnormal tendon tissue and longitudinal tenotomies 5.

Important Clinical Pearls

• Most patients (80%) fully recover within 3-6 months with appropriate conservative treatment 1, 5
• This is a degenerative tendinopathy (tendinosis), not an inflammatory tendinitis, despite the common misnomer 1, 8
• Avoid complete immobilization as it leads to muscle atrophy; tensile loading stimulates proper collagen alignment 1, 6
• Technique modification is essential: The patient must stop or significantly modify ice cream scooping activities during treatment, or the condition will not resolve 1

Common Pitfalls to Avoid

• Don't inject corticosteroids directly into the tendon substance as this can cause tendon rupture; only peritendinous injections should be considered 1
• Don't progress eccentric exercises too quickly; mild discomfort during exercise is acceptable, but pain should not persist afterward 6
• Don't rely solely on NSAIDs or corticosteroids without addressing the underlying repetitive activity and implementing eccentric strengthening 1, 5