Diagnosing Wrist & Hand Repetitive Use Injuries

NYU Langone orthopedists diagnose and treat many types of repetitive use injuries to the hand and wrist. These injuries are common in people who participate in sports, such as tennis, golf, or baseball, that require the repetition of a specific movement. They also occur in people who perform repetitive movements during daily activities, such as typing or lifting a baby.

Tendinitis

The most common repetitive overuse injury in the hand and wrist is tendinitis. This condition occurs when a tendon—a cord of tissue that connects muscles to bones—becomes inflamed as a result of irritation or stress. Swelling of the surrounding soft tissue is also common, along with tenderness and pain. 

Symptoms tend to worsen during and after physical activity, and they may worsen over time. 

De Quervain’s Tenosynovitis 

De Quervain's tenosynovitis is an irritation of the tendons that run from the wrist to the thumb. These tendons are encased in a snug, tunnel-like tissue called a sheath. Repetitive movements of the thumb and wrist, or a direct blow to the area, may irritate these tendons and cause them to swell, hindering their movement through the sheath and causing you pain. 

Activities that may lead to de Quervain’s tenosynovitis include knitting and needlepoint; jobs that involve twisting the wrist, like using a screwdriver; or excessive video game playing involving small movements of the thumb. The condition is often seen in new mothers, because of underlying swelling caused by repetitive lifting of a baby.

Stenosing Tenosynovitis

Stenosing tenosynovitis is commonly known as “trigger finger,” because it can cause a finger to become stuck in a bent position. Flexor tendons, which are located on the palm side of your hand, allow you to bend and flex your fingers. They are enclosed in a protective covering called a synovial sheath, which produces a fluid that keeps the tendons lubricated, allowing them to slide easily through the sheath.

If you put stress on your fingers—for instance, by playing an instrument, using hand tools, or operating a machine frequently—the tendons may swell. Inflammation may also cause the sheath to constrict. The tendons then can’t move easily through the sheath, leading to slower and sometimes painful bending and flexing of the fingers.

People with mild stenosing tenosynovitis may feel a painful popping sensation when they straighten their fingers. If the condition is more severe, one finger can become stuck in a bent position. Stenosing tenosynovitis often leads to finger or thumb stiffness, pain, and swelling. Swollen tendons can also cause a small lump, called a nodule, to develop where the palm meets the affected finger.

Trigger finger is more common in women, and it usually occurs in people 40 to 60 years old. 

Capsulitis

Joints are surrounded by bands of tough, fibrous connective tissue called ligaments that form a capsule around the joints and allow them to function properly. Capsulitis occurs when this capsule becomes inflamed. 

Capsulitis can occur in any joint in the body. When the thumb is overused, inflammation can occur in its joints, causing pain and stiffness. This condition is sometimes referred to as “texting thumb,” because texting has recently become a leading cause of capsulitis in this part of the body. 

Muscle or Tendon Strain

A muscle or tendon can overstretch or tear if you engage in excessive amounts of physical activity or if you put too much stress on a body part or muscle during exercise. This is known as a strain, or a pulled muscle, and it can cause pain and difficulty in moving the injured muscle. It may also cause swelling or bruised skin. Muscle strains are common among musicians, who make repetitive movements with their hands and fingers while playing an instrument, and people who start a new exercise routine without warming up properly. 

A strain is different from a sprain, in which a ligament—tissue that connects two bones—stretches or tears. 

Diagnostic Tests

To determine if you have a hand or wrist overuse injury, NYU Langone specialists ask about your symptoms and medical history and perform a physical examination of your arm, hand, and wrist. They may also check for strength, sensation, and signs of nerve irritation or damage. Imaging tests are often used to get a clearer look at the damage the condition may have caused.

X-rays

X-rays use electromagnetic radiation to create pictures of the inside of the body. If you have limited wrist motion due to pain, your doctor may recommend an X-ray to rule out the various causes of pain in this area, including arthritis, recent trauma, or past injury.

MRI Scans

MRIs use magnetic fields and radio waves to create computerized, three-dimensional images of the structures in your body. Your doctor may order an MRI to view ligaments and tendons in the hand and wrist.