Tendinitis by definition is inflammation, and any activity that requires a repetitive motion especially in sports that can require great amounts of force generated by these movements put the patient at risk for inflammation. By not treating the inflammation the patient risks instability, and possibly even rupture. For all tendinopathies, the foundation of treatment has been early diagnosis with activity modification, anti-inflammatory medications (like NSAIDS) and braces.
Extensor Carpi Ulnaris Tendinopathy
The extensor carpi ulnaris is located in the 6th dorsal compartment on the ulnar (medial) side of the wrist and those that engage in racket sports and golf seem to be at the highest risk. It presents acutely, with one sided wrist pain on the ulnar (inside) side of the wrist and is diagnosed with tenderness over the involved tendon. The physician may also engage the wrist in ulnar deviation during active wrist extension, and if this results in pain then ECU tendinopathy is the likely culprit.
De Quervain’s Tenosynovitis
This involves primarily the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons which are located in the first dorsal compartment in the wrist. It is associated more in women especially postpartum as the position they hold the baby in repetitively is thought to contribute to the overuse inflammation; but other activities like racket sports and rowing are also risk factors. The patient will notice that the area over the radial styloid can be tender or swollen. The physician will usually employ the Finkelstein test; the patient will close the hand into a fist and the physician will deviate the wrist ulnarly. Resulting pain with appropriate risk factors will point to De Quervains Tenosynovitis.
This has been associated with sporting activities that involve extension with radial deviation of the wrist joint repetitively; these include weightlifting, racket sports, and skiing among others. A nickname for this is “crossover tendonitis” as it occurs in the anatomical location of the distal forearm where the tendons of the first dorsal compartment intersect with the tendons of the second dorsal compartment. The patient will feel pain on the radial side, on the dorsal aspect of the wrist about 4 cm proximal to the wrist joint; occasionally crepitus or a creaking/popping sensation can also be felt if severe.
Flexor Carpi Radialis (FCR) Tendonitis
Any sportsman with repetitive wrist motion, especially flexion of the wrist with radial deviation, is at increased risk of this condition. The location of the tendon itself puts this tendon at risk as it courses adjacent to numerous wrist bones before its attachment point and can get inflamed by repetitive rubbing on the bone. The pain is usually located on the volar, radial side of the wrist and the patient will notice tenderness over the tendon and when the flexion with radial deviation is repeated, pain will usually be exacerbated. This all points towards likely FCR tendonitis
Flexor Carpi Ulnaris (FCU) Tendonitis
This will clinically present with pain on the ulnar aspect of the wrist and is exacerbated by flexion with ulnar deviation. Risk factors once again include athletes with repetitive wrist motions especially ones that exacerbate the discomfort.
While the above is a good discussion of different types of wrist tendinitis, nothing replaces a consultation with a health care professional who is trained to put together the clinical picture into a cohesive diagnosis and can utilize other measures when the picture is not typical. In fact, it is noteworthy that ulnar sided lesions can have a tricky diagnosis due to the anatomy and the sometimes vague clinical presentation and often MRI’s are ordered for them. It is also wise to seek quick diagnosis as complications of tendinitis can require operative treatment, which is always best to be avoided if not necessary.