Certain common tendinitis conditions that occur in the hand and wrist are caused by entrapment of the tendon under tight structures. These structures, known as pulleys, normally function to hold the tendon in the correct place and allow it to glide smoothly. For a variety of reasons, these pulleys may tighten and cause the tendon to become restricted, resulting in the pain, swelling, and decreased motion seen with tendinitis (See DeQuervain’s and Trigger Finger). Often, tendinitis will respond to non-operative management such as rest, splints/orthoses, activity modification, anti-inflammatory medications, and specific exercises targeting the involved structures. When non-operative management fails to control your symptoms, your doctor may recommend surgery to release the tight pulley and allow the underlying tendon to glide more smoothly and without pain.
Tendons attach muscles to bones and enable us to be able to bend and move our joints. Many tendons in the hand and arm are located just beneath the skin and can be easily cut or injured with even minor trauma. Injuries to tendons affect your ability to fully move your joints properly. Some tendon injuries can be treated with immobilization, while most require surgical repair. During surgery to repair a cut tendon, your doctor will stitch the tendon ends back together. It is important after surgery to protect the repair and to closely follow your doctor and therapist’s instructions to gradually mobilize the repaired tendon.
Some conditions require working tendons to be transferred to non-working tendons (e.g. nerve injury, tendon rupture, stroke and cerebral palsy.) This type of procedure is called a tendon transfer. There are certain tendons in the arm that can be safely rearranged without sacrificing function, with the goal to restore or improve an absence of function. After tendon transfer surgery, you will need to protect the transferred tendon and will be seen in therapy to help maximize the function of the newly transferred tendon.
A tenolysis is the surgical release of a tendon from surrounding adhesions (scar) that prevent full active motion. This may be needed after an injury that damages a tendon, or a crush or other trauma that causes significant swelling (edema) in the hand. Surgery is indicated only if conservative treatment methods have been unsuccessful in regaining functional mobility.
The Hand Center is known worldwide for its pioneering work related to wrist reconstruction. Numerous publications and presentations over a period of more than thirty years have provided a major contribution to our understanding of common patterns of injury and degeneration of the wrist and innovative treatment approaches. Our goal is to preserve as much function and mobility as possible, with elimination of pain. Conditions that may require wrist surgery/reconstruction include rheumatoid arthritis, osteoarthritis and traumatic injury. There are a number of surgical options depending on the severity of the involvement and the functional needs of the patient. Options range from a simple synovectomy (removal of inflamed joint tissue) or localized excision of the involved portion of the joint, to a procedure that reconstructs the wrist, such as a limited wrist arthrodesis (partial fusion).