By John E. Blank, MD
Tendinitis is a painful condition that can occur in anyone as a result of muscle-tendon unit overload at its origin, insertion or beneath its synovial sheath. Typically, tendinitis is an irritation or inflammation of the sheath that surrounds the tendon that causes pain and loss of motion. In this post, we’ll examine how tendinitis forms, especially in different parts of the arm, hand and wrist.
How Tendinitis Forms
There are many reasons why tendinitis can form in the arm, wrist and hand. Repetitive motions like those used in painting, throwing, raking or other activities can lead to the condition, as can stresses from arthritis, certain medications like anti-inflammatories, and, rarely, infection.
Tendinitis vs. Tendinosis
In the wrist and hand, it is most likely the sheath the tendon moves within that becomes inflamed, rather than the tendon itself, that results in painful tendon movement or excursion. (de Quervain’s tenosynovitis and trigger finger) In the elbow, there is no sheath surrounding the tendon, so the condition actually impacts the tendon itself. It microscopically tears off the bone and can take a long time to heal (lateral and medial epicondylitis).
Tendons that travel in sheaths are susceptible to tendinitis, where the tendons without sheaths more commonly develop tendinosis. Tendinosis in the elbow, also called tennis elbow, when the pain is lateral, or golfer’s elbow when the pain is medial, is a form of tendinosis but often gets lumped into tendinitis complaints.
Tendinitis vs. Bursitis
In the shoulder, tendinitis can occur in the rotator cuff. This is very common, and can be associated with bursitis, which is a condition where the sacs called bursa that normally contain fluid become inflamed and swell. This swelling causes pain because the joints and bones cannot slide and glide together comfortably.
Tendinitis in the Wrist
The wrist contains 6 separate compartments for the wrist extensor tendons all of which can develop tendinitis. Commonly, extensor tendinitis involves the thumb extensor tendons, the digital extensor tendons, and the ulnar wrist extensor to the thumb (as discussed below) but not the one on the opposite side, (or the ECU tendon). Radial wrist pain, or De Quervain’s tenosynovitis, starts at the base of the thumb and involves the sheath that the tendons of the thumb travel through. The tendons control the movement of the thumb, and when they become inflamed it leads to this painful disease.
Pregnancy can cause excess bodily fluid that crowds the tunnel between the wrist and thumb, causing pain and discomfort. Post-partum mothers may associate radial wrist pain when lifting their children. It is also possible to develop arthritis at the base of the thumb, so pain in that location requires a bit of clinical differentiation to rule out symptoms that mimic to tendinitis. Central wrist extensor tendinitis involves the digital extensor tendons and may be related to repetitive activities or overuse syndromes. Pain over the ulnar head at the wrist is frequently a result of ECU tendinitis.
Tendinitis in the Hand
On the palm side of the wrist, the most common form of tendinitis occurs in the “trigger finger.” This type of tendinitis occurs because of a narrowing of the flexor tendon sheath and is really not the fault of the tendon, but the sheath itself that thickens and calcifies over time. The result is a mismatch between tendon and sheath site that yields pain, clicking and even digital locking.
If you’re worried you may be experiencing tendinitis in the arm, or your elbow, wrist, or hand pain persists for weeks, contact us today.