Review of Tendon Disorders of the Hand and Wrist
It is quite likely that the most common injuries to the hand and wrist are those affecting the tendons. And, although they are common and have been known about for a long time, there are still disagreements and uncertainty as to how to treat some of them. In earlier days, it was thought that tendon injuries were caused by inflammation and this is why they were given their names: tendonitis, tenosynovitis, and tendovaginitis - with itis meaning inflammation. However, this isn't always the case. The author of this article reviews evaluation and management of common tendon disorders and discussed in recent medical literature to clear up some misconceptions.
Although many injuries are caused by traumas (falls, for example) most tendon disorders in the hand and wrist are idiopathic, which means they are of unknown cause. Some people are at higher risk of tendon-related disorders, such as those with diabetes.
Many have made a connection between tendon disorders and workplace activities, but this isn't always the case and can be controversial. Eighteen papers focusing on this connection and, upon review, there wasn't much data to support a general work and tenosynovitis connection. That being said, there are some factors that can help identify people who may be at higher risk of developing tendon disorders and these include people who are over 40 years old, have a body mass index of over 30, already have complaints of shoulder or neck problems, have a history of carpal tunnel syndrome, or have jobs that require higher shoulder posture.
When looking at the affected tendons of patients who have trigger finger or de Quervain's disease, there is no inflammation seen on the tendon and there seems to be more of a breakdown of the pulley system in the tendon system that causes the problem. In de Quervain's disease, researchers also found that the tissue is denser, up to five times as much as the tendons of people who do not have the disease.
Two researchers, Hueston and Wilson, once described the tendon as it moves over certain points and becoming damaged is "akin to that seen when a large, braided thread is passed through the slightly smaller eye of a needle." Another disorder, chondroid metaplasia also doesn't have inflammation, but an invasion of other tissue that causes the original tissue to become hardened.
Other tendon disorders haven't been studied as widely as those just mentioned. For some, there have been inflammations, both acute and chronic, noted. But, the question is did the inflammation cause the problem or did the problem cause the inflammation?
Because of the lack of usefulness in calling tendon disorders with an "itis," indicating inflammation, there is a movement to begin using the term tendinopathy, which would indicate a degeneration or using the suffix -osis to indicate and abnormal state or condition.These suggestions have not yet taken off.
Treatment with corticosteroid injections is the usual first-line treatment for tendon disorders in the hand and wrist. The treatment has been fairly successful, but there have not been many studies to back this up.
John A. McAuliffe, MD. Tendon Disorders of the Hand and Wrist. In The Journal of Hand Surgery. May 2010. Vol. 35. No. 5. Pp. 846-853.