Wrist tendonitis and carpal tunnel syndrome

This is pain that overburdens the wrist, a joint that is small yet, at the same time, very resilient. Usually, there is an identifiable explanation, such as wrist tendonitis or carpal tunnel syndrome. This article will address these clinical conditions and other important points related to this discomfort. Understanding the difference at an earlier stage allows for earlier action and avoids unnecessary aggravation.

• Wrist tendonitis: inflammation/irritation of a tendon (or the tendon sheath). The pain usually worsens with certain movements, with load, and with palpation of a specific area.
• Carpal tunnel syndrome: compression of the median nerve inside the carpal tunnel. Here, the main problem is neurological.

Where they overlap

• They can coexist: the same overload that irritates tendons can also increase pressure in the carpal tunnel (local swelling, wrist flexion/extension postures, grip strength).
  
• One can “mimic” the other: wrist pain due to tendonitis can cause a feeling of discomfort in the hand; and carpal tunnel may be felt as a vague ache in the wrist, especially at night.
• Inflammation and edema around the wrist (due to tenosynovitis/tendonitis) can aggravate symptoms of carpal tunnel, because there is less space for the nerve.

How to distinguish them by their most typical signs

• Tendonitis: more localized pain (often on the thumb or little finger side, depending on the tendon), worsening when moving against resistance; there may be “clicking” or a feeling of friction.
• Carpal tunnel: tingling/numbness primarily in the thumb, index, middle, and half of the ring finger; worse at night or when driving/holding a phone; feeling of a “numb” hand and, in more advanced stages, weakness in pinch grip (buttons, keys, opening jars).

What worsens these conditions?

Certain habits increase pressure on the tendons and the median nerve.

• Prolonged use of a keyboard and mouse without adequate breaks;
• Sustained wrist flexion, such as when using a phone in hand for a long time;
• Repetitive manual work with high grip force;
• Resting the wrist on a rigid surface for hours;
• Sleeping with the wrist bent.

Medical Help

Seeking medical evaluation (or physiotherapy with a medical referral when necessary) should be even more urgent if there is:

• Tingling or numbness in the thumb, index, middle, or half of the ring finger, especially if it appears at night;
• Loss of strength for pinch grip, dropping objects, difficulty opening jars, buttoning clothes, holding the phone;
• Pain that does not improve after 10–14 days, even with load adjustment and breaks.
• Pain that progressively worsens or starts to interfere with simple day-to-day tasks;
• Pain after a fall/trauma, marked swelling, deformity, or inability to use the hand normally;
• Symptoms in both hands, or associated with pain that radiates up to the forearm;
• Diabetes, hypothyroidism, pregnancy/postpartum, or any other situation that increases the risk of carpal tunnel.

The consultation will be helpful with the following points:

• Distinguishing tendon from nerve with a targeted clinical examination and specific tests.
• Determining if there is compression of the median nerve and if there is already a deficit in sensation/strength.
• Defining what should be reduced, maintained, and adapted (there are big differences between “total rest” and specific load adjustments).
• Deciding whether temporary immobilization, a night splint, anti-inflammatories, injections, physiotherapy, or complementary exams make sense.
• Identifying the source of the problem: ergonomics, training patterns, manual labor, or even systemic causes.

While waiting for the consultation

There are some measures that can be taken so the situation does not worsen, for example, while waiting for the appointment:

• Reduction of repetitive tasks and varying positions throughout the day.
• Avoiding sleeping with the wrist bent (a simple night splint may help, if it is already a habit to wake up with tingling and there are appropriate conditions for its use).
• Frequent short breaks from the keyboard/mouse and avoiding resting the wrist on rigid surfaces.
• Adjusting training: less grip load, less volume, and swapping out exercises that cause pain.

Night Splint

The night splint is especially useful for carpal tunnel syndrome in early or moderate stages. The goal is to keep the wrist in a neutral position during sleep, reducing pressure on the median nerve.

It makes sense to consider using one when there are:

• Frequent nighttime numbness or tingling.
• Pain that wakes the person up several times a week.
• Symptoms that improve by stretching or shaking the hand.

The splint should not be overly tight or cause additional pain. It is a symptomatic control measure and may reduce progression in early stages. Its use should not replace a clinical evaluation.

Furthermore, in the context of joint tendonitis, this support may be useful temporarily during more painful phases, but the focus should be on load management and progressive strengthening. Just as in the previous circumstance, specialized professional evaluation is equally essential in this scenario.

Prevention

Who is more prone

There are profiles at higher risk who should consequently be more attentive to early signs:

• Pregnancy and postpartum: this is a period where carpal tunnel is more common, often due to hormonal changes and fluid retention, and it may improve after delivery, although it does not always disappear completely.
• Diabetes, hypothyroidism, and rheumatoid arthritis: are associated with a higher probability of carpal tunnel syndrome.
• Overweight: associated with a higher risk of carpal tunnel, even when other factors are considered.
• Work or training with high repetition and grip force (tools, heavy loads, gym with strong grip, many hours of keyboard/mouse usage): increases the typical exposure of both tendons and nerve compression.

Caring for your body today is an investment in your well-being and mobility for tomorrow.
— Aveimédica