Wrist Tendonitis Surgery – What is Wrist Tendonitis?

Wrist Tendonitis Surgery

The human hand is one of the most intricately designed part of the human body.

• Muscles in the forearm connect to the fingers in hand through long, thick cords made of collagen-fiber,called tendons. There are several tendons, grouped as flexors and extensors. Flexors, on the inside of the forearm control bending of fingers and movement of the wrist. They run through the front of the wrist and are held in place with a lateral band called carpal tunnel ligament of flexor retinaculum. The extensor group of tendons on the outside or back of the forearm enable opening up of the hand.
• There are several small muscles in the hand for fine movement, grouped as lumbricals and interossei.
• Two major nerves – median or carpal-tunnel nerve and ulnar nerve give sensation to the fingers and small muscles in the hand.
• Two arteries – radial and ulnar carry blood from the forearm to fingers of the hand.

What is Wrist Tendonitis?

The above tendons are covered in a tissue called synovium. The tendon and the synovium are covered in a protective sheath all around. Wrist tendonitis, also called tendinitis or tenosynovitis is a condition in which the tendons, specifically in the wrist region get inflamed, swollen or irritated. As a result, the synovium swells up. This changes the shape of the outer sheath, making it difficult for the tendons to move. The person experiences pain and tenderness in the wrist and thumb. The most common type of the condition is DeQuervain’s tendonitis which manifests as pain in thumb-side of the wrist.

Causes and Risk factors of Wrist Tendonitis

• Sports: Repetitive motion and constant gripping of the racket or bat in tennis, badminton, squash and cricket place stress on the wrist. Improper technique while playing these sports also increases the risk.
• Work and leisure: Any job or activity where the person is picking gripping, reaching overhead, repeatedly, uses the hand in awkward positions, or forcefully exerts the hand or wrist to pick up or carry load, can cause pain in the wrist tendons. People in assembly lines, logistics business and gardening are all at risk. Chopping and hammering actions, when done repeatedly add to the risk (carpenters). Writing, texting on the keypad, playing videogames and typing on the keyboard for long stretches of time– all add to the risk.
• Age: Middle-aged people and seniors are more at risk than youngsters as the tendons naturally lose strength and elasticity with age.
• Injury: Slips, falls, and direct impact to the wrist in an accident can cause damage to tendons in the wrist triggeringthis condition.
• Ailments: Rheumatoid arthritis, autoimmune diseases and diabetes can also contribute to pain in the wrists.
• Genetic: Poor alignment of the tendons in the wrist since birth can trigger this condition.

Symptoms of Wrist Tendonitis

• Dull pain in the wrist that gets worse with time
• Warmth, redness, tenderness and numbness in the wrist area
• Swelling and inflammation in the wrist
• Reduced mobility of the wrist making texting or typing painful and difficult
• Grinding or creaking sensation or noise whenever the wrist is moved
• Weakness or lack of strength in the wrist, inability to hold or lift anything for long
• Stiffness or lack of flexibility in the wrist joint, which reduces range of motion
• Sharp, shooting pain in the wrist and fingers, especially the thumb

Diagnosis of Wrist Tendonitis

The first step is to assess precisely where the inflammation is and how severe the condition is. An orthopedic doctor will conduct physical examination and stretch tests to determine location and extent of pain. He/she will also assess the patient’s personal and family medical history, professional and leisure activities. All these help analyze the cause of the condition.

Treatment for Wrist Tendonitis

Once the diagnosis is done, the doctor will try various non-surgical options for treatment. This may extend between 3 to 6 months depending on the severity of the condition. Only when nothing is working out, will surgery be recommended. Non-surgical options are:

• Ice: This is the first line of home treatment. An ice-pack is applied on the wrist to reduce inflammation and stimulate blood flow.
• Physical therapy: Various hand exercises that help improve the range of motion in the wrist.
• Immobilization: A splint is put on the patient. This immobilizes the wrist and gives the thumb and wrist some rest, for natural healing.
• Anti-Inflammatory Medications: Non steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen are prescribed to reduce inflammation and swelling
• Cortisone Injection: A couple of cortisone-steroid injections are given to the outer sheath of the concerned tendon.
• Shockwave therapy – The wrist is exposed to high-energy sound waves (ultrasound) or electrical stimulation is given to reduce pressure on the tendons and ligament that surround the joint. This helps reduce the pain.
• Autologous blood injections: Soft tissue regeneration is stimulated by injecting blood from the patientat the inflamed tendon.
• Platelet-rich plasma: PRP is injected into the wrist to reduce inflammation
• Dry needling: A very thin needle is used to create holes in the wrist tendon to promote healing
• Ultrasonic treatment: Here, a small incision is made at the wrist and ultrasonic waves applied there, in order to remove scar tissue

Surgery for Wrist Tendonitis

Open Surgery: This is of different types:

 Tendon sheath release: This helps release the constricting tissue surrounding the concerned tendon

• Tenosynovectomy: Similar to above, but here the tissue is inflammatory in nature
• Tendon grafting: A tendon from another part of the body is grafted at the wrist to restore function
• Tendon transfer: The problematic tendon is moved to another part of the body, to restore functionality at the wrist joint
• Tendon repair: Here, the torn tendon is surgically repaired or re-attached to bone

Minimally invasive surgery: Again of 2 types 

• Arthroscopy: An endoscopic procedure to repair the concerned area
• Tenotomy: Needles are inserted into the wrist in order to cut the concerned tendon

Outlook

If you or your dear ones are exhibiting symptoms listed above, contact a reputed hospital. Orthopedic specialists there will diagnose your condition and put you on a course of treatment for quick recovery and rehabilitation.