What is the best treatment approach for a patient with overuse tendinitis of the wrist?

Treatment of Wrist Overuse Tendinitis

Start with relative rest, ice application, and eccentric strengthening exercises as the foundation of treatment, as approximately 80% of patients with overuse tendinopathies fully recover within 3-6 months with conservative management alone. 1

Understanding the Condition First

Most wrist overuse injuries are degenerative tendinopathies ("tendinosis"), not inflammatory conditions ("tendinitis"), which fundamentally changes the treatment approach. 1 This distinction is critical because anti-inflammatory treatments may not address the underlying degenerative process. 1

Initial Conservative Management (First 3-6 Months)

Core Treatment Components

• Relative rest is essential to prevent further tendon damage, but avoid complete immobilization which causes muscle atrophy and deconditioning. 1, 2

• Cryotherapy provides effective acute pain relief using repeated applications of melting ice water through a wet towel for 10-minute periods. 3, 2

• Eccentric strengthening exercises are highly effective and may actually reverse degenerative changes in the tendon, making them the cornerstone of rehabilitation. 1, 3, 2

Pain Management Options

• Topical NSAIDs are effective for pain relief with fewer systemic side effects than oral formulations. 3, 2

• Oral NSAIDs provide effective symptomatic pain relief, though they should not be prioritized over other analgesics for long-term use. 1, 2

• Corticosteroid injections can relieve pain but should be used with caution and limited to 2-3 injections maximum. 1, 4

Adjunctive Physical Therapy

• Deep transverse friction massage may help reduce pain in tendinopathies. 3, 2

• Stretching exercises are widely accepted as beneficial. 2

• Therapeutic ultrasound may decrease pain and increase collagen synthesis, though evidence of consistent benefit is weak. 4

When Conservative Treatment Fails

Surgery should be reserved only for patients who have failed 3-6 months of well-managed conservative therapy. 1, 3, 2, 4 This is appropriate since 80% of patients recover without surgical intervention. 3, 4

Critical Pitfalls to Avoid

• Do not mislabel chronic degenerative conditions as inflammatory "tendinitis" when they represent "tendinosis," as this leads to inappropriate treatment focus. 3, 4

• Address underlying biomechanical issues and technique problems (especially in athletes or workers with repetitive tasks), as failure to do so leads to recurrence. 3, 2

• Avoid complete immobilization that causes muscle atrophy and deconditioning. 2, 4

• Do not rely solely on NSAIDs or corticosteroids for long-term management, as they provide short-term pain relief but do not address the degenerative process. 1, 5

Treatment Algorithm

1. Weeks 0-2: Relative rest, ice application (10 minutes multiple times daily), topical or oral NSAIDs for pain control 1, 3, 2

2. Weeks 2-6: Continue rest modifications, begin eccentric strengthening exercises, add deep friction massage 1, 3, 2

3. Weeks 6-12: Progress eccentric exercises, address biomechanical factors, consider corticosteroid injection if pain significantly limits function 1, 4

4. Months 3-6: If no improvement, consider advanced modalities (shock wave therapy, ultrasound-guided injections) 4, 5

5. After 6 months: Surgical consultation if conservative measures have consistently failed 1, 3, 2, 4