Understanding Tendonitis: From Wrist Mechanics To Real Fixes

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Welcome back to the hand-to-shoulder solution where pain meets its match. I'm Carl Petito. I'm an occupational therapist and a board-certified hand therapist. I specialize in the rehabilitation of orthopedic conditions affecting the fingertips through the shoulder. Really important if you're having any pain anywhere and just don't let it go on for a long time. Get in to be seen by your healthcare professional sooner versus later. It's always easier to fix if we get to it sooner versus later. Alright, let's talk about a couple of things. I want to demystify some wrist and thumb pain, and let's talk about tendonitis. So to review, itis means inflammation. In this case, it's inflammation of the tendon, tendonitis. And we have a lot of tendons around the wrist, in fact, there's 24. And tendons connect muscles to bones. Alright. So muscles only pull, they don't push. So when the muscles pull on the tendons, they move the skeleton. So you can have tendonitis of any of the wrist tendons, and depending on what people are doing, if they're you know doing uh bench press wrong and they're on a hyperextended wrist, or if they're uh scrubbing the I I treat a lot of people who clean for a living, also a lot of people who are doing body work on cars and they're they're pressing and always pushing and using maybe one muscle group frequently, or people that work on assembly lines, and then just the tendons start to get irritated, they start to swell up, they start to become tender, and it'll eventually get so bad that it hurts even when you're just sitting there not doing anything, and then it hurts worse when you're doing things, and we have to get that tendonitis, we need to get that inflammation to calm down. So let's go around the wrist, and there is one muscle right here called the ECU, extensor carpi ulnaris. So in the clinic, we just say instead of saying extensor carpi ulnaris, we say ECU. And that muscle does this and it does this, so that's wrist extension and wrist ulnar deviation. And then we have extensor carpi radialis longus, ECRL, extensor carpi radialis brevis, ECRB. So those tendons, ECRL, on the outside, it does this and it does this. So wrist extension and radial deviation. And then ECRB, extensor carpi radialis brevis, does wrist extension. So any of those can be aggravated, and there is a strap of material that holds those tendons down against the bone. So when you're moving, you don't get bowstringing, it's not gonna pull away and you know do anything like that when you're moving because there's that strap of ligamentous material, so ligaments connect bone to bone, and the ligament, this wide ligament, starts on a bone and ends on a bone. Okay, there's a couple of them, and we're at the end of the video. I'm gonna talk specifically about a very common problem, uh, tendonitis condition with the thumb that's very important that we talk about in a couple of quick, easy tips. For you got that problem when you're picking up your thumb and it just hurts a lot on the thumb side of your wrist. I'm gonna show you what to do. Alright, so that is a friction point because that is holding the tendons down against the bone, and they're gliding underneath that. So let me just show you here. These there's one wrist tendon here, these are some finger tendons, and then these other tendons right here on the on the thumb side of the wrist on the back of the hand side, um that's where they're located, and then all the red portion is muscles, so you can just have an appreciation of how many muscles are around the what we call the flexor compartment, the polymer surface of the forearm, and the extensor compartment, the back of the forearm. Alright. Now, going around the other side, there's FCR, flexor carpia radialis, that that flexes the wrist and it moves it toward the thumb. And then you have FCU, flexor carpi ulnaris, it flexes the wrist and ulnar deviates the wrist. So the wrist movements we have flexion, extension, ulnar deviation, radial deviation. So there's a lot going on there, there's a lot of mechanics. There's 15 bones in the wrist, 24 ligaments that connect everything, 24 tendons that connect muscles to bone, all crossing, all crossing the wrist. The carpal tunnel is made up of eight carpal bones within the wrist, and we talked about those in some detail on uh on um on previous videos. So I recently had a case where someone came in and they were having pain right here on the tendon called FCR, flexor carpia radialis, and it was really sore. So the person was rubbing that. It's natural to want to rub something that's sore because, for example, if you hit your shin on something, what's the first thing you do? You reach down and rub it, and deep pressure releases chemicals that decrease pain. But here it's just skin and tendon and ligament and bone, and when you're rubbing it, the trap is that it feels great the whole time you're rubbing it. Then when you stop, now the inflammation is increased. And then you naturally remember, oh, it felt great when I was rubbing it. So it's a vicious cycle. And I explained this to patients so they can immediately start working on fully stopping the habit. So if it's sore in your wrist and hand, don't rub it, and that that absolutely makes it worse. Also, using too much heat, heat expands, and it's already hot and aggravated and swollen. It's an itis condition. Tendonitis, itis means inflammation. So it's already hot and aggravated and expanded. We want to cool that down with cold. And I'll tell you what's a lot better than a cold pack for 10 minutes. It's cold running water for 10 to 20 seconds. So you can stick that wrist under cold running water only until deeply cold, which should take 10 to 20 seconds. And then people do that lunchtime, after work, after dinner, and before bed. Or more often, I and I tell folks, hey, whenever you wash your hand, just end with cold running water, get to the deeply cold, knock down that inflammation. So occasionally, what we'll have to do is fabricate a custom molded wrist splint to number one not make any contact with that area that's inflamed and aggravated, and number two, give stability to the wrist so they can use their hand without aggravating that area. The splint can be designed to literally relax that muscle or that muscle group so that uh there's no more pulling stress, tensile stress on that tendon. Now, one of the most common um places of inflammation of the tendons is at the thumb. And by the way, I just want to say one thing we do in the clinic is we resist those muscles, those motions to determine is that tendon problematic? And then remember, tendons connect muscle to bone. So if the muscle is really tight, and that happens a lot just from overwork, if the muscle is tight, that means it's in a shortened position, which means it's putting more pulling stress on the tendon, which is called tensile stress, T-E-N-S-I-L-E. More tensile stress on the tendon. So, as a therapist, what I want to do is restore the length of the muscle. So if now the muscle is back to its natural length, it's not pulling as hard on the tendon that connects it to the bone. So we'll use several different techniques for that, which are also discussed in other episodes, and we'll go into further detail in later episodes. But back to the thumb. Now, when you pull your thumb back, you can probably see a couple of tendons uh poke up out of the skin. Now, there's there's three main main ones. So the first one is abductor pollicis longus, APL. So that one that that does this, and then there's extensor pollucus brevis, and that pulls the thumb up, and then a tendon that swings way out over way out over here, goes this direction, extensor pollicis longus. So watch this extensor abductor pollicis longus APL pulls the thumb away from your palm, and that's located right here. Extensor pollicis brevis. If I have my thumb tip down, I'm picking it up. That's this tendon right there, that's that cord. Now, if I pick my the tip of my thumb up and I resist that, this one pops up even more. That goes way over here, and the muscle is up in here. Alright? Now, it's these first two that I'm concerned about right here, these first two tendons right there. If I'm using a scissors or something that are too tight, and as I'm picking opening those scissors, the this tendon right there is getting a lot of stress. And if these scissors require a lot of force, and let's say I'm a barber or I'm just doing something with scissors frequently, which I am in the clinic, this condition started to happen to me because I was cutting a lot of padding for custom splints that I was making, and I was getting a lot of adhesive between the scissors, and also this screw was too tight. So I loosened the screw and now I make sure I keep my scissors clean. Guess what? My tendon minus went away. So now I can use the scissors easier. I'm not having this tendon pop up as hard, means meaning that there's not as much tension on it. So it allowed it to calm down, and then keeping the scissors clean, they they work nice and smoothly. So that's very important to pay attention to. Also, new mothers. I see a lot of new mothers with the tendonitis of the thumb, they're opening the thumb really far, forcefully, and getting underneath their child's arms to pay pick up their child anytime possible. If the mother feels safe enough, it's ideal to keep the thumbs inside against the hand, so you have a flat hand, and then get underneath the armpits, grab your child, and that prevents those tendons from getting overstressed. There's a sheath, so there's um a thick heavy ligament that holds those tendons down against the bone, and the tendon themselves, the tendon itself glides through a sheath that's full of lubricating fluid. So the name of this condition is decorvanes tenosinovitis. So there's that itis again. Okay, it's inflammation. Tino synovitis. Tino for tendon, senophersynovial sheath. That's a sheath that goes around the tendon that's full of this lubricating fluid. And then the uh and the itis part is the inflammation. So this if this goes on for a long time and it doesn't, you don't get in and get this fixed, and it's you know, it's more people is it's been going on for a year, year and a half, and uh chances are therapy is not going to be as very effective. Um usually they start out the folks will start out with an injection, we'll still try some therapy, but if that doesn't work, and if the person has to have surgery, the surgeon will go in here and release this ligament and debreed or remove uh scar tissue that forms and this area gets really, really thick. So it's called a release. So it's a lit literally a surgical release of the pressure on this area. What do I do as a therapist? So get into the office as soon as possible. As soon as the patient gets in, I fabricate a thumb spica splint, a custom splint that keeps the tip of the thumb free, so they can still use the fingertips to the tip of the thumb. And because that muscle is not involved in that compartment, it's in a different compartment. But these muscles, the first two that I talked about, the APL and EPB, they are involved, so the split holds the thumb, and then it's a gutter right over the uh thumb side of the forearm, and then just a little piece that kind of holds a hand here. So it's minimalistic. There's one, two, three straps, some nice padding, and then I wean out of the wean the patient out of the forearm splint by cutting it down eventually into a hand splint, which allows wrist motion, still stabilizes the thumb, and then eventually we get rid of the thumb split. At the same time, we're doing some cold laser treatment, we're doing some ultrasound, we're doing some specific stretches. How often do patients with this come into the office? Once a week, once so, and then probably for the first couple of weeks, and then once every two weeks for a few sessions. So it's not coming into the office. People hear therapy, they think, oh my goodness, three times a week, I have to go a lot. No. And in the office, I'm doing things for you that you can't do for yourself at home, and I'm coaching you through modification to the home program. So, as you can see, it's a lot of details. If something's going on, you're having pain somewhere, get in sooner rather than later. It makes it easier on you, and we can get it fixed. So, thanks a lot for sharing this with other people who might be having any discomfort from their fingertips through the shoulder. Anybody has any questions? Thank you for subscribing to the channel at the Hand to Shoulder Solution, where we are the solution to your pain.