Tendinopathy refers to disease of a tendon — encompassing both tendinitis (acute inflammation) and tendinosis (chronic degeneration). A tendon tear is a partial or complete disruption of tendon fibers. The hand and wrist contain numerous tendons connecting forearm muscles to the bones of the hand and fingers, enabling fine motor movement and grip, and any of these can be affected by overuse, trauma, or systemic disease.
Tendon problems in the hand and wrist frequently occur alongside other pathology. When inflammation involves the tendon sheath rather than the tendon itself, this is classified as tenosynovitis — a closely related condition covered on its own page. Tendon tears around the wrist may also be associated with TFCC tears or ulnar abutment syndrome, particularly when affecting the extensor carpi ulnaris tendon on the ulnar side of the wrist.
Causes
- Overuse and repetitive motion: The most common cause of tendinopathy. Repetitive gripping, typing, lifting, or tool use overloads tendons and causes microscopic damage that accumulates over time.
- Acute trauma: Lacerations, falls, or forceful stretching can cause partial or complete tendon tears. Flexor tendon injuries often result from deep cuts to the palm or fingers; extensor tendon injuries from crushing or cutting to the back of the hand.
- Occupational factors: Assembly line work, construction, typing, and use of vibrating tools — particularly with repetitive gripping or awkward wrist positions — increase risk significantly.
- Sports activities: Tennis, golf, rock climbing, weightlifting, and racquet sports place significant stress on hand and wrist tendons.
- Age-related degeneration: Tendons become less elastic and more prone to injury with age, making degenerative tears more common in older patients.
- Systemic conditions: Rheumatoid arthritis — which commonly causes extensor tendon rupture at the wrist — diabetes, gout, and other systemic conditions increase tendon vulnerability.
- Medications: Fluoroquinolone antibiotics (such as ciprofloxacin) and corticosteroids have been associated with tendinopathy and spontaneous tendon rupture.
- Anatomic factors: Bone spurs, prior fractures with irregular surfaces, or anatomic variations can cause tendons to rub against bone, leading to chronic inflammation and tearing.
Symptoms
Symptoms vary depending on which tendon is affected and whether there is tendinopathy or a tear:
- Pain: Along the course of the affected tendon, worse with use — sharp, burning, or aching depending on acuity.
- Swelling and tenderness: Localized swelling and tenderness to touch along the tendon.
- Stiffness: Particularly noticeable in the morning or after inactivity.
- Weakness: Reduced strength with movements requiring the affected tendon. With a complete tear, the associated motion may be absent.
- Crepitus: A creaking or grating sensation with tendon movement.
- Visible deformity with complete tears:
- Mallet finger: Inability to straighten the fingertip — extensor tendon tear at the DIP joint.
- Boutonnière deformity: Bent middle finger joint with extended fingertip — central slip rupture.
- Dropped finger: Inability to extend a finger at the knuckle — extensor tendon rupture at the MCP joint.
- Inability to flex a finger: Flexor tendon rupture.
- Popping sensation: A sudden pop or snap at the time of acute tendon rupture.
- Triggering: In trigger finger, the tendon catches and releases as it moves through an inflamed sheath — see tenosynovitis.
Diagnosis
Physical examination includes inspection for swelling and deformity, palpation for tenderness, evaluation of active and passive range of motion, strength testing, and specific provocative tests — such as the Finkelstein test for De Quervain's tenosynovitis. Characteristic deformities such as mallet finger or boutonnière can make the diagnosis immediately apparent on examination.
When the diagnosis is uncertain, when a partial tear needs to be distinguished from tendinopathy, or when surgical planning is required, a hand MRI or wrist MRI is the definitive imaging study. MRI can identify tendinosis, partial tears, complete ruptures, and associated abnormalities such as tenosynovitis — all in a single non-invasive examination. Ultrasound is a useful adjunct for real-time tendon evaluation and injection guidance. X-rays are obtained to rule out fractures, calcifications, or arthritis contributing to tendon problems.
Classification
- Tendinitis: Acute inflammation of the tendon with pain, swelling, and warmth.
- Tendinosis: Chronic degeneration without significant inflammation — characterized by disorganized collagen and abnormal tendon structure on MRI.
- Tenosynovitis: Inflammation of the tendon sheath surrounding the tendon — see dedicated page.
- Partial tear: Incomplete disruption of tendon fibers with some intact fibers remaining.
- Complete tear (rupture): Full disruption of all tendon fibers with loss of function of the associated movement.
Treatments
Treatment depends on the type and severity of tendon pathology, location, patient age, and activity level.
Conservative treatment for tendinopathy: Rest and activity modification to allow tendon healing, ice for acute pain and swelling, splinting or bracing to reduce tendon strain, NSAIDs for pain and inflammation, and hand therapy with targeted eccentric strengthening exercises — which have strong evidence for chronic tendinopathy. Corticosteroid injection can reduce acute inflammation but should be used sparingly due to the risk of tendon weakening with repeated injections. Platelet-rich plasma (PRP) injection and extracorporeal shockwave therapy are emerging options for refractory tendinopathy.
Surgical treatment for tendon tears in active patients
Complete tears generally require surgical repair, particularly flexor tendon injuries which do not heal spontaneously. Surgical options include:
- Tendon repair: Direct suture repair of torn tendon ends — most effective when performed soon after injury before retraction and scarring occur.
- Tendon transfer: A nearby functioning tendon is redirected to restore lost motion when direct repair is not possible in chronic tears.
- Tendon grafting: A tendon graft bridges a gap in a torn tendon when the ends cannot be brought together directly.
- Tenolysis: Surgical release of scar tissue and adhesions around a tendon to restore gliding and range of motion.
- Tendon sheath release: For trigger finger or De Quervain's tenosynovitis — surgical release of the constricted sheath resolves mechanical catching and pain.
Older or lower-demand patients with partial tears
Partial tears that do not significantly impair function may be managed conservatively with splinting, therapy, and activity modification — particularly in older or lower-demand patients who would prefer to avoid surgery.
Rehabilitation
Hand therapy following tendon surgery is critical. Carefully graduated exercise protocols — including early controlled motion programs for flexor tendon repairs — are designed to restore tendon gliding while protecting the repair. Full recovery after tendon surgery typically takes 3–6 months or longer depending on the procedure and tendon involved.
Get an MRI to Confirm Your Diagnosis
Before surgical planning or starting treatment, a clear MRI diagnosis ensures the right path forward. First Look MRI offers self-pay Wrist MRI scans — no doctor's order or insurance required — at our locations in Georgia, Texas, and Colorado.