The pain and tingling in your hand and fingers are getting worse. Rest, medications, and physical therapy has not helped. Your doctor is not certain but mentioned tendonitis and Carpal Tunnel Syndrome. What is tendonitis? What causes Wrist Tendonitis? What are the symptoms? What are the treatment options for Wrist Tendonitis? What is Carpal Tunnel Syndrome? What are the most common causes of Carpal Tunnel Syndrome? What are the symptoms and treatment options for Carpal Tunnel Syndrome? Are there effective nonsurgical regenerative options? What is the difference between Wrist Tendonitis vs Carpal Tunnel Syndrome? Let’s dig in.
What is Tendonitis?
Tendons are thick pieces of connective tissue that connect muscle to bone. Tendons function to move bones or a given joint. For example, when a given muscle contracts, it pulls on the tendon. The tendon in turn moves the bone to which it is attached. Tendonitis is an inflammation of the tendon (1). The wrist and hand have a large number of tendons. They can be classified into two major groups based on their function: Flexion and Extension
Wrist Flexion is the action of curling the hand downward
Wrist Extension is the opposite of wrist flexion. It involves raising the back of the hand upward.
The flexor tendons are located on the underside or palm side of the wrist. They are responsible for flexion of the wrist. They include flexor carpi radialis (FCR) flexor carpi ulnaris (FCU) and palmaris longus (PL). The image to the left illustrates two of these muscles and tendons. The tendon is the white portion of the structure that attaches to the bone whereas the red is the muscle. Again, they are located on the palm side of the wrist.
In contrast, the extensor tendons are located on the backside of the wrist. There are many. They are divided into six extensor compartments that are designated by Roman numerals: Compartment I, II, III, and so on. Each compartment is a tunnel that contains one or more of the extensor tendons. An extensor tendon is illustrated in purple in the picture to the right. Note the tendons are the backside of the wrist (where your knuckles are).
Causes of Wrist Tendonitis (Repetitive Activity, Trauma, Age, DM, Weight)
There are many causes of flexor and extensor Wrist Tendonitis. The major ones include:
Repetitive Motion Injuries: examples include writing, texting, typing, and playing a musical instrument.
Trauma
Weak or damaged wrist ligaments. To learn more click here.
Poorly positioned bones in the wrist/hand
Arthritis (2)
Diabetes (3)
Age: Over 40 years of age (4)
Increased BMI (4)
Symptoms of Wrist Tendonitis (Pain along Tendon)
Pain directly over the affected tendon is the most common complaint in patients diagnosed with Wrist Tendonitis (5). The pain is made worse with activity. It typically involves only either the right or left wrist. Other symptoms of Wrist Tendonitis include:
There are three principal treatment options for Wrist Tendonitis: conservative, injections, and surgery. Treatment options depend upon the severity of the injury.
Conservative Care
When appropriate first-line treatment should always be conservative therapy. The goal is to reduce inflammation. Treatment options include:
Immobilization: A splint is oftentimes helpful.
Anti-Inflammatory Medications: Good quality fish oil and Tumeric are great choices. Nonsteroidal anti-inflammatory medications such as Motrin and Alleve should be avoided due to their significant side effects. These include an increased risk of heart attack, stroke, organ damage and damage to gut health. To learn more please click here.
Physical Therapy: Aims to reduce inflammation, stretch chronically tight muscles and strengthen the wrist joint
Injections
If conservative care fails oftentimes patients are referred to steroid injections. Common names include Dexamethasone, Betamethasone, and Hydrocortisone. While steroids are powerful anti-inflammatory agents they are also toxic to the tendons (5). To learn more about the negative side effects of steroids and why you should avoid them please click here.
Surgery
Rarely is surgery indicated for Wrist Tendonitis.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a painful medical condition in which the median nerve is irritated or compressed at the level of the wrist. It is the most common nerve entrapment condition affecting approximately up to 20% of adults in the general population (6). An estimated one million adults from the United States (annually) have CTS requiring medical treatment (7).
The carpal tunnel is a narrow passageway located on the palm side of the wrist. It is made up of tendons, ligaments, and bones. It allows 9 flexor tendons and the median nerve to pass safely across the wrist into the palm. It is illustrated in the picture to the right. Swelling within the carpal tunnel results in irritation and or compression of the median nerve. OUCH!
Causes of Carpal Tunnel Syndrome (Local, Regional and Systemic)
There are multiple causes of Carpal Tunnel Syndrome. They can be divided into three principal causes: Local, Regional, and Systemic (whole-body) (8).
Local Causes
Trauma
Tumors: expanding tumor can compress the median nerve.
Inflammation: tendons and the surrounding sheaths called synovium can be inflamed.
Regional Causes
Osteoarthritis
Rheumatoid Arthritis
Gout
Systemic Causes (Whole Body)
Diabetes
Obesity
Low Thyroid
Pregnancy
Autoimmune Disorders such as lupus, scleroderma, and sarcoidosis.
Occupation and Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is the most common form of repetitive trauma disorder. Occupations at risk include grinders, cashiers, meat packers, car seat sewers, grocery store clerks, and small part assembly line employees (9).
Physical forces also play an important role in the development of carpal tunnel syndrome. These include repetition, force, posture, and vibration (10).
Symptoms of Carpal Tunnel Syndrome ( Pain and Numbness)
Symptoms vary depending upon the severity of the nerve irritation or compression. Symptoms usually start gradually and occur in both wrists in approximately 55-65 % of cases (8). Pain and numbness are the most common symptoms and classically involve the thumb, index middle, and inside portion of the ring finger (and headaches have been connected to carpal tunnel syndrome). The pain can be burning in nature. Other symptoms include:
Waking up with pain or numbness that feels better by “shaking out” your hand
Nightime pins and needle sensations in hand and fingers
Clumsiness or weakness in hand or hands
The sensation of hand and fingers being swollen
Muscle wasting in severe cases
Carpal Tunnel Syndrome Treatment Options
Treatment options depend upon the severity of the injury. and clinical symptoms. Like Wrist Tendonitis, there are three principal treatment options:
Conservative Care
When appropriate first-line treatment should always be conservative therapy. The goal is to reduce inflammation. Treatment options include:
Immobilization: A splint is oftentimes helpful along with work restrictions
Trial of oral anti-inflammatory medications. Good quality fish oil and Tumeric are great choices. Nonsteroidal anti-inflammatory medications such as Motrin and Alleve should be avoided
Oral steroids (11)
Physical Therapy. Carpal bone mobilization, nerve glides, ultrasound treatment, and yoga have been shown to provide significant short term benefit (12)
Injections
When conservative treatment measures fail patients are oftentimes referred for injections. Steroids injections are the most common as they are powerful anti-inflammatory agents. They should be avoided as they are toxic to tendons, ligaments, and cartilage.
Surgery
When both conservative care and steroid injections fail many patients are referred for surgical consultation. Carpal tunnel surgery involves cutting the roof of the carpal tunnel which is made up of the transverse carpal ligament. In doing so the compressed/irritated median nerve is relieved. There are many different ways this can be accomplished including using open surgery, endoscopically, or using ultrasound and a cutting device. A newer solution, nerve hydrodissection not does involve cutting the transverse ligaments but frees us the scar tissue around the nerve. Surgical complications can and do exist (13). They include:
Infection
Nerve damage
Instability in the wrist bones due to the cutting of a critical ligament
Failure of the procedure to relieve symptoms
Pain at the surgical site
Complex regional pain syndrome (CRPS)
To learn more about the complications and recovery from carpal tunnel surgery please click here.
Non-Surgical Treatment Options
At the Centeno-Schultz Clinic, we are experts in the treatment of Carpal Tunnel Syndrome. We have been successfully using an ultrasound-guided procedure for many years with excellent results. It is called the Perc-Carpal Tunnel Scar Release. Under ultrasound, the scar tissue around the median nerve is released thereby reducing swelling in the surrounding tendons and median nerve. Instead of using high-dose steroids which can hurt nerves and tendons (14), we use a patient’s own platelet-derived growth factors which can reduce inflammation, increase blood flow, and promote healing.
The use of PRP has been shown to be superior to steroid shots in the treatment of Carpal Tunnel Syndrome (15).
The procedure is challenging and can not be performed by your PCP or orthopedic surgeon. To see an ultrasound-guided Carpal Tunnel procedure please click on the video below.
Differences Between Wrist Tendonitis vs Carpal Tunnel Syndrome?
Wrist Tendonitis and Carpal Tunnel Syndrome are two distinct clinical conditions. Both can cause significant pain and dysfunction in the hand and wrist. Tendonitis affects tendons whereas carpal tunnel syndrome affects the median nerve. Tendonitis causes pinpoint pain along the affected tendon whereas carpal tunnel syndrome’s presentation varies and can include pain, numbness, and tingling in the wrist, palm, and fingers. The pain of tendonitis is typically localized on the side or backside of the wrist whereas Carpal Tunnel Syndrome involves the palm side of the wrist, palm, and fingers. Tendonitis typically affects one wrist whereas bilateral involvement is common in Carpal Tunnel Syndrome. Both are warning signs that you have a problem that warrants your attention. If untreated tendonitis can progress to a tendon tear whereas Carpal Tunnel Syndrome can cause permanent nerve damage and muscle weakness. These differences are summarized in the chart below.
In Conclusion
The question of Wrist Tendonitis vs Carpal Tunnel Syndrome needs to be answered as accurate diagnosis is crucial to appropriate treatment. Tendonitis is the inflammation of the tendon. There are a large number of tendons in the wrist that can be divided into groups based upon their action: Flexor and Extensor tendons. There are multiple causes of wrist tendonitis. The most common include repetitive motion, trauma, and increasing age. Pain directly over the affected tendon and swelling are the most common symptoms. Treatment options for wrist tendonitis include conservative care, steroid injections, and surgery. Steroid injections should be avoided due to their toxicity and possible tendon tears. Surgery is rarely indicated. Carpal Tunnel Syndrome is a painful condition in which the median nerve is irritated or compressed at the level of the wrist. The causes of Carpal Tunnel Syndrome can be divided into three principal groups: local, regional, and systemic. Repetitive trauma is a common cause of carpal tunnel syndrome. Symptoms vary depending upon the severity of the nerve irritation or compression. Pain and numbness are the most common. Treatment options include conservative care, steroids, and surgery. Surgical risks include infection, nerve damage, wrist instability, failure to relieve symptoms, and complex regional pain syndrome. Ultrasound-guided injections of PRP are an effective alternative to carpal tunnel surgery. The procedure is called Perc-Carpal Tunnel Scar Release and has been used extensively at the Centeno-Schultz Clinic in Broomfield, Colorado.
If you or a loved one suffers from tendonitis or carpal tunnel syndrome pain please schedule a telemedicine consultation to learn about the best treatment options and for an accurate diagnosis of Wrist Tendonitis vs Carpal Tunnel Syndrome. From the comfort of your own home, backyard, or cabin speak with a board-certified, fellowship-trained physician who can review your history and radiographic studies. Wrist and hand pain is a warning sign that you have a problem that warrants investigation. Tendon and carpal tunnel pain left untreated typically get worse with an escalation in pain and reduced motion and potentially permanent nerve damage. Don’t risk dependence on NSIAD or narcotics. Stop the suffering and schedule today.
10.Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors and carpal tunnel syndrome. Am J Ind Med. 1987;11(3):343-58. doi: 10.1002/ajim.4700110310. PMID: 3578290.
