Wrist tendinopathy

[barryelliswhite]

My daughter, aged 21, is a classical harpist. Six months ago was diagnosed with an intersection syndrome, rested six months with physical therapy 2 x wk. The pain on the dorsum of the wrist cleared up. Now she has developed pain over the flexor tendons in the wrist (right hand). Her treating orthopedist, a hand specialist, has basically said there is nothing to be done and she will have to give up music. She is devastated by this and is wondering if anyone with any experience in tendinopathy have anything to suggest. I am a neurologist, but knowq sweet nothing about tendinitis. Please reply to my e-mail, barryelliswhite@netscape.net.

[injuryupdate]

My daughter, aged 21, is a classical harpist. Six months ago was diagnosed with an intersection syndrome, rested six months with physical therapy 2 x wk. The pain on the dorsum of the wrist cleared up. Now she has developed pain over the flexor tendons in the wrist (right hand). Her treating orthopedist, a hand specialist, has basically said there is nothing to be done and she will have to give up music. She is devastated by this and is wondering if anyone with any experience in tendinopathy have anything to suggest. I am a neurologist, but knowq sweet nothing about tendinitis. Please reply to my e-mail, barryelliswhite@netscape.net.

This is a difficult condition to treat and it sounds as if she may need to have an extended rehab period and time off playing but I would strongly advise a 21 year old musician with a tendinopathy process against retirement from a pursuit she loves. Yes, tendinopathy is a degenerative condition, but unlike degenerative arthritis, in an adult body new collagen can be laid down and remodelled to eventually form functioning tendon.

The principles of managing tendon disorders are:
(1) Load management - in this case it sounds as though load will need to be decreased significantly, perhaps with the help of a wrist brace, to get to a point where swelling and symptoms settle. However, eventually the patient needs to start reloading the area and gradually building strength back up.
(2) Eccentric exercise - with minimal load initially, exercises where the tendon is being loaded whilst being stretched (done by the thumb resisting a force pushing downwards on it from above) are part of the regime to restrengthen
(3) Injection treatment can help. Aprotinin is not available in the USA but if there is a lot of swelling and relative rest is being undertaken then I still believe cortisone has a role. Otherwise there are many other injection options. Surgery, which doesn't generally help for most tendinopathies, has a better prognosis in intersection syndrome if a chronic bursa develops, which can be removed.

There isn't much on the injuryupdate site on intersection syndrome, because it is more commonly an occupational problem than sports injury (although rowers can suffer it) but the principles from athletic tendinopathies can be applied. I would virtually never advise a 21 year old athlete to retire due to a tendinopathy process.