Flexor Carpi Ulnaris and Flexor Carpi Radialis Tendinitis

with Rehab

Tendonitis is a condition that involves inflammation of a tendon, which is a soft tissue that connects muscle to bone. The flexor carpi ulnaris (FCU) and flexor carpi radialis (FCR) tendons are vulnerable to tendonitis. The FCU and FCR are used for bending the wrist and gripping. FCU and FCR tendonitis may include inflammation of the tendon lining (sheath). The lining normally secretes fluid that allows the tendons to function smoothly, but when it is inflamed, function is impaired. This condition may also include a tear in the FCU or FCR tendon or muscle (strain). The strain may be classified as grade 1 or 2. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains include a lengthened ligament, due to the ligament being stretched or partially torn. With grade 2 strains, there is still function, although function may be decreased.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness on the underside of the wrist.

  • Pain that gets worse when bending the wrist, especially against resistance or when turning the palm down against resistance.

  • Pain with gripping.

  • Limited motion of the wrist.

  • Crackling sound (crepitation) when the tendon or wrist is moved or touched.

  • Numbness in part of the palm of the hand.

CAUSES

FCU and FCR tendonitis are caused by injury to the FCU and FCR tendons. This is often due to chronic or repeated injuries, but may also be due to severe (acute) injury. Common causes of injury include:

  • Strain from unusual use, overuse, increase in activity, or change in activity of the wrist, hand, or forearm.

  • Repeated motions of the hand and wrist, due to friction of the tendon within the lining (sheath).

RISK INCREASES WITH:

  • Sports that involve repeated hand and wrist motions (i.e. golfing, bowling).

  • Sports that require gripping (i.e. tennis, golf, weightlifting).

  • Heavy labor.

  • Poor wrist and forearm strength and flexibility.

  • Failure to warm up properly before activity.

  • This condition is more common in women than in men.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow the body to recover between activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique.

PROGNOSIS

If treated properly, FCU and FCR tendonitis is usually curable with 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or if not given adequate time to heal.

  • Chronically inflamed tendon, causing persistent pain with activity, that may progress to constant pain, restriction of motion of the tendon within the sheath, and may potentially rupture the tendon.

  • Recurring symptoms, especially if activity is resumed too soon.

  • Risks of surgery: infection, bleeding, injury to nerves, continued pain, incomplete release of the tendon lining, recurring symptoms, cutting of the tendon, and weakness of the wrist and grip.

TREATMENT

Treatment first involves the use of ice and medicine to reduce pain and inflammation Performing stretching and strengthening exercises regularly is important for a quick recovery. These exercises may be completed at home or with a therapist. Your caregiver may recommend the use of a brace or splint to reduce motions that aggravate symptoms. Corticosteroid injections may be recommended. If non-surgical treatment is unsuccessful, surgery may be necessary.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Cortisone injections may be given, to reduce inflammation. However, these injections should be reserved for serious cases, as they may only be given a certain number of times.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery: increased pain, swelling, redness, drainage of fluids, bleeding in the affected area, or signs of infection.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Flexor Carpi Ulnaris and Flexor Carpi Radialis Tendinitis

These exercises may help you when beginning to recover from your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION – Wrist Flexion, Active-Assisted

  • Extend your right / left elbow with your fingers pointing down.*

  • Gently pull the back of your hand towards you, until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

RANGE OF MOTION – Wrist Extension, Active-Assisted

  • Extend your right / left elbow and turn your palm upwards.*

  • Gently pull your palm and fingertips back, so your wrist extends and your fingers point more toward the ground.

  • You should feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

STRETCH - Wrist Flexion

  • Place the back of your right / left hand on a tabletop, leaving your elbow slightly bent. Your fingers should point away from your body.

  • Gently press the back of your hand down onto the table by straightening your elbow. You should feel a stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Wrist Extension

  • Place your right / left fingertips on a tabletop leaving your elbow slightly bent. Your fingers should point backwards.

  • Gently press your fingers and palm down onto the table by straightening your elbow. You should feel a stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Flexor Carpi Ulnaris and Flexor Carpi Radialis Tendinitis

These exercises may help you when beginning to recover from your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up and fully supported on a table. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight, or holding a piece of rubber exercise band or tubing in both hands, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position, in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported on a table. Your elbow should be resting below the height of your shoulder Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight, or holding a piece of rubber exercise band or tubing in both hands, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position, in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit while holding onto a rubber exercise band or tubing in both hands, with your healthy arm supported on a table, and your injured arm below the table.

  • Move only your right / left wrist, so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day

STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit while holding onto a rubber exercise band or tubing in both hands, with your right / left arm supported on a table, and your healthy arm below the table.

  • Raise your right / left hand upward in front of you, so that your thumb moves toward your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Grip

  • Grasp a tennis ball, a dense sponge, or a large, rolled sock in your hand.

  • Squeeze as hard as you can, without increasing any pain.

  • Hold this position for __________ seconds. Release your grip slowly.

Repeat __________ times. Complete this exercise __________ times per day.