Tendinopathy (Tendonitis)

There are 23 tendons that cross the wrist into the hand. They work in concert to produce the movements of the wrist and hand required to perform delicate tasks, repetitive activity and the powerful work we sometimes require of our hands.

Tendon injury can be caused through direct trauma, overuse, incorrect use or wear and tear and the ageing process. The word tendinopathy is used to describe all types of symptoms in the tendons, and it is often switched for other terms such as tendinitis, tenosynovitis, and tenovaginosis.

DeQuervain's Splint

Hand Therapy treatment for Tendinopathy

An accurate assessment of a patient's history, the onset, type and behaviour of the symptoms including the movements which cause problems is a part of the initial examination. Following this interview, a thorough assessment of all the tendons in the area is conducted and a diagnosis is made by the hand therapist. Further investigation may include an ultrasound examination.

Splinting is a feature of conservative treatment, and a custom made splint will often be made by the hand therapist at the initial appointment. A short period of splinting, combined with trigger point massage, ergonomic assessment and education on the things to avoid are the first step.
The second stage of rehabilitation is strengthening the muscle/tendon unit to ensure it regains the capacity to return to the demands made of the arm in everyday life.
This second stage of rehabilitation is the crucial step to recover the function in the arm, and avoid recurrences and set backs.

Additional treatments to alleviate the painful symptoms include hand and arm massage, and ergonomic advice. Individual advice, treatment and recommendations are made which will address specific sporting, musical, manual handling, or ergonomic situations as they relate to each case.
A graduated return to playing (music or sport) schedule is provided to patients who are recovering from a tendinopathy.
A graduated return to work program is used for those with workplace related tendinopathy.

Current research*

Modern tendinopathy management follows a few straightforward rules based in current research.

Tendons hate change and compression

Tendons respond to the load they are put under by strengthening and weakening (load removed).
Changes in load need to be applied slowly. For example, when work demands increase, care needs to be taken to make incremental increases and adjust to the new workload over days and weeks, not hours. Similarly, when making a recovery from an injury, the return to sport, work or playing your instrument must also be approached gradually and methodically.
Your tendons will talk to you 24 hours after you have loaded them up. It might not be apparent at the time that you are causing a flare up.

Tendons love slow heavy load

Your hand therapist will guide you in the type and dosage of exercises that tendons recover with.
Isometric exercises are usually the first step in the rehabilitation program for tendinopathy.

References

J L Cook and C R Purdam. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br. J. Sports Med. 2009;43;409-416; originally published online 23 Sep 2008;doi:10.1136/bjsm.2008.051193
JL Cook and CR Purdam. The Challenge of Managing Tendinopathy in Competing Athletes. Br J Sports Med published Online First: May 10, 2013 doi:10.1136/bjsports-2012-092078
K Fallon, C Purdam, J Cook, G Lovell. A "Polypill" for Acute Tendon Pain in Athletes with Tendinopathy? J Sci and med in Sport (2008) 11, 235-238

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