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A Description of Tendon Injures in the Hand and Wrist
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Posted on: 11/30/1999
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This article by Adams et all is a basic review of different injuries which can happen to tendons in the hand and wrist. There are many tendons that run through the wrist and into the hand and injuries are common. Tendinopathy is an affliction to the tendon anywhere along its course. Tendinosis means that there is chronic degenerative changes to the tendon often with the absence of inflammatory cells. It is suggested that due to the lack of good blood flow through the tendon and increased strain, the healing and remodeling response is slowed, resulting in a chronic painful condition.
Trigger finger, also scientifically know as stenosing tenosynovitis, is when the tendons running out to the fingers become bound up in the pulleys they run through at the base of the fingers. This can occur due to degeneration or overuse which causes the tendon to thicken. This thickened tendon is not able to glide smoothly through the pulley structures around the base of the finger and can get stuck. This injury is more common in women than men and has a higher incidence in people with diabetes mellitus or rheumatoid arthritis. Treatment with a corticosteroid injection is common with a positive response rate of sixty to ninety per cent for the first injection. It has been shown that subsequent injections are less successful. Physical therapy is another common treatment. If conservative treatment fails, surgery is an option. This includes a release of the pulley at the location of the pain to allow increased space for the tendons to glide smoothly.
De Quervain tenosynovitis effects the tendons along going into the thumb called the abductor pollicis longus and the extensor pollicis brevis. This is most common with post partum period after pregnancy and during breast feeding. It is usually a result of activities that require repeated wrist movement toward the thumb side, such as hammering, cross country skiing or lifting a child. Treatment usually includes NSAIDS, splinting, physical therapy, corticosteroid injection, and if needed surgery is an option. This surgery involves releasing the sheath which these tendons run under on the thumb side of the wrist.
The flexor carpi radialis is a unique tendon that runs just to the thumb side of the carpal tunnel. It runs right over, and sometimes is enclosed in, the trapezium (one of the tiny wrist bones). But this narrow tunnel makes this tendon vulnerable to pinching and fraying from bone spurs that may develop nearby. This is more challenging to diagnose as there can be several other issues with pain in this region, including injury to the bones in the area or arthritis of the joints in the area as well. X-ray and MRI can assist in the diagnosis if needed. Treatment again includes rest, splinting, ice, NSAIDS and sometimes physical therapy or cortisone injections are useful. Surgery can be indicated if there is evidence of large bone spurs that may risk tendon rupture. This may include cleaning up fraying of the tendon and increasing the size of the tunnel.
Less common are intersection syndrome, extensor pollicis longus tenosynovitis, fourth compartment tenosynovitis, fifth compartment tenosynovitis and extensor carpi ulnaris tenosynovitis. These are usually caused from overuse or occasionally from injury to the specific location of each tendon. The treatment for all of these rare conditions will first include rest, activity modification, physical therapy, ice and NSAIDS. Corticosteroid injections can be considered for these as well.
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References:
Adams, Julie E., MD. et al. Tendinopathies of the Hand and Wrist. In Journal of the American Academy of Orthopaedic Surgeons. December 2015. Vol. 23. No. 12. Pp. 741-750.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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