When symptoms persist in spite of nonoperative treatment, clinicians offer surgical treatment. Although the authors do not believe these injections will improve overall performance, sports vary regarding their specific testing parameters and banned substances, and thus the medical personnel and the athletes should be aware of the specifics for their sports. Although the level of steroid used for injection is typically very low, athletes in competitive leagues, in which testing is performed for performance-enhancing medications, should be aware of possible testing parameters for banned substances before having an injection. Most of these conditions respond to nonoperative treatment with activity modification, antiinflammatory medications, hand therapy, and corticosteroid injections. If the diagnosis is uncertain or the patient fails nonoperative treatment, advanced imaging may help. Diagnosis for tendinopathies in the hand and wrist is predominantly made on clinical examination. Many of these typically do not cause the athletes to lose time from their sports because treatment is symptomatic and rarely time specific. Hand and wrist tendinopathies are commonly seen in athletes, ranging from contact to noncontact racquet/stick sports. Surgical intervention may be offered in those patients who fail nonoperative treatment. Nonoperative management, consisting of rest, activity modification, antiinflammatory medications, temporary splinting or bracing, hand therapy, and possibly steroid injections, plays a pivotal role. Most cases can be diagnosed with history and physical examination alone, with the need for advanced imaging in recalcitrant cases. Therefore, he has vast experience in performing ultrasound on tenosynovitis and treatment, including injections.Sports-related tendinopathies of the hand and wrist are common and are predominantly related to overuse. He combines working at East Coast Physio, with performing diagnostic ultrasound for several radiology departments based in NHS hospitals. Neil Liffen currently combines his working week as an Extended Scope Physiotherapist and as a Musculoskeletal Diagnostic Sonographer. If you would like further information on diagnosis, treatment and/or management please contact Neil Liffen. Occasionally, it is necessary to perform investigations and ultrasound is a useful early investigation in ruling in or out tenosynovitis and/or other pathology. Due to the complexity of the structures at the wrist diagnosis from physical examination can be challenging. In the majority of cases your symptoms will settle within normal healing times of 6-12 weeks. The other two most commonly injured are the sixth (extensor carpi ulnaris – Figure 2) and second (intersection syndrome) compartments. The first compartment is the most frequently affected site, called De Quervain’s disease. Any of the dorsal compartments of the wrist can develop tenosynovitis. Tenosynovitis is the inflammation of the fluid-filled tendon sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. The wrist is prone to injury, commonly due to trauma, repetitive strain injury and/or through inflammatory conditions, such as rheumatoid arthritis and can cause tenosynovitis. These sheaths reduce the friction to the extensor tendons as they traverse the compartments that are formed by the attachments of the extensor retinaculum to the distal (far end) of the radius and ulna. As the tendons travel over the posterior (back) aspect of the wrist they are enclosed within synovial tendon sheaths. The extensor tendons are held in place by the extensor retinaculum. The extensor tendon compartments are anatomical tunnels on the dorsal wrist and these tendons allow you to predominantly extend (lift up your fingers). Commonly, the dorsal wrist has twelve tendons, divided into six compartments, with some compartments crossing over each other. An example, of the complexity of our anatomy can be demonstrated at the dorsal wrist (back of your hand). In completing a BSc Physiotherapy and MSc Diagnostic Musculoskeletal Ultrasound, Neil has always been fascinated by the human anatomy and learning ligaments, tendons, muscles etc. This time, Neil Liffen, director of East Coast Physio Ltd (ECP) discusses the wrist anatomy with particular emphasis on the back of the hand and common sites of tenosynovitis.
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