Hand and wrist tendinopathies

Abstract

More than half of all occupational disorders can be attributed to chronic tendinous pathologies [1]. A large percentage of these involve the hand and wrist, and constitute a significant economic burden to society. The risk of hand and wrist tendinopathy in patients who perform highly repetitive and forceful jobs is 29 times greater than in patients who perform jobs that are low in repetitiveness and force [2]. A number of terms have been used to categorize wrist and hand tendon disorders in the literature, including overuse injury, repetitive strain injury and, more recently, cumulative trauma disorder (CTD).These terms reflect a common presumed etiology based on repetitive loading leading to tendinopathy and/or tenosynovitis. Chronic tendon disorders are also frequently seen in various sporting activities, both at professional and amateur levels. Racquet sports in particular are commonly associated with wrist and hand tendinopathies [3,4]. Other sports commonly associated with wrist tendinopathies include golf, weightlifting, gymnastics, and bicycling [3,4,5]. Because of the complex organization of tendons about the wrist and hand, reaching an exact diagnosis can be difficult. This chapter has been arranged by anatomical site in order to contrast diagnoses. Common differential diagnoses for each region are presented in tabular form (Table 15-1). Regardless of the etiology, chronic tendon disorders generally respond to nonoperative management, but frequently require lengthy treatment with unpredictable outcomes. The initial course of nonoperative treatment is generally the same regardless of anatomical site. Surgical intervention in tendon pathology can present important technical challenges. The authors' preferred surgical approach will be discussed in detail within each anatomical subsection.