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Tendinitis literally means inflammation of a tendon. The extensor tendons are the tendons on the back of the wrist and hand, while the flexor tendons are on the palmar side of the wrist and hand. These tendons pass through distinct compartments alone or in groups. When the tendons become irritated, their ability to glide within these compartments is restricted, causing wrist and hand pain during movement and tenderness when direct pressure is applied.
If tendons are sufficiently stressed, from excessive and unconditioned use or a direct blow, the sheath lining can become inflamed and movements may be painful to varying degrees as the tendons glide through the inflamed sheath.
Tendinitis can be caused from overuse of a limb during some atypical activity. For example, if a person undertakes a massive spring cleaning, the wrist is usually held in a hyperextended position as the palm exerts the pressure. The extensor tendons at the wrist level are strained and tendon sheaths become inflamed. In contrast, planting a winter garden may involve more forceful wrist flexion as small spades are repeatedly drawn toward the body. This strains the wrist flexor tendons which may become painful with wrist motion, tender to direct pressure and possibly swollen.
To help prevent tendinitis, one should try to not overdo any activities that use a lot of wrist motion, such as cleaning, gardening, or office activities such as typing, filing and writing. One should be careful about suddenly increasing the time spent on these activities, i.e. typing for three days straight to finish a report--even though you rarely type. Conditioning is not just important to athletes. In order to help avoid musculoskeletal ailments, everybody needs to have adequate conditioning for whatever activities they pursue. During these activities, close attention also should be paid to the positioning of the wrist and hand. Try to maintain the wrist in a neutral position and avoid any excessive flexing (bending the wrist forward) and extending (bending of the wrist backward).
The particular movements created by the specific tendons are usually painful and even more so if the movement is resisted by the examiner. At times, the lining of the sheaths will swell to the point that a squeaking, rubbing sensation will be prominent. There may be some swelling in the region of the inflamed tendon sheath depending on the location and thickness of the patient's subcutaneous (under the skin) fat layer. There may or may not be warmth or redness associated with the swelling.
A good history which describes the activities and movements which recreate the pain will usually lead to an accurate diagnosis. Unless the condition has atypical characteristics or is recalcitrant to standard treatment efforts, diagnostic tests such as ultrasound, x-rays or MRIs are not necessary.
The treatment is the same for flexor tendinitis as extensor tendinitis, and only rarely does it require surgical treatment. The appropriate treatment of rest, immobilization and anti-inflammatory medications will usually lead to resolution within three weeks.
Inflammation of a tendon and its sheath responds well to rest via activity modification. The offending activities must be avoided at least until the symptoms abate. If the symptoms are severe enough, complete immobilization in a cast or splint may be necessary, although rarely for more than three weeks. In certain cases, carefully placed steroid injections may be very helpful.
