Wrist Extensor Tenosynovitis Treatment London | Private Ultrasound Diagnosis & Injections

Wrist Extensor Tenosynovitis Explained

Wrist Extensor Tendon Anatomy

The extensor tendons of the wrist, hand, and fingers provide anchorage for the outer forearm muscles, allowing them to assist with lifting activities and to extend the wrist and fingers.

It is uncommon for these non-weight-bearing tendons to develop significant tendon degeneration or damage. However, the extensor tendons of the wrist pass through a series of tunnels known as tendon sheaths, each located in bony grooves along the dorsal aspect of the wrist.

These sheaths are stabilised by soft tissue structures, which prevent bowstringing when the tendons are placed under load.

What Causes Wrist Extensor Tenosynovitis?

The tendon sheaths of the wrist extensor tendons can become inflamed — a condition known as wrist extensor tendon tenosynovitis.

Common causes include:

• A direct blow to the upper wrist or forearm

• Repetitive activities causing friction and inflammation

• Frequent typing

• Repetitive use of touch screens

How is Wrist Extensor Tenosynovitis Diagnosed

Wrist extensor tenosynovitis can be extremely well diagnosed by a point of care ultrasound scan due to the superficial nature of the structures involved and ultrasounds capability of clearly distinguishing fluid within the tendon sheath, tendon tears and irregularities to the body of the expensive tendons as well as imaging the underlying joint structures to exclude other causes of pain and swelling.

Wrist Extensor Tenosynovitis Ultrasound Guided Injections

How is a Wrist Extensor Tendon Sheath injection administered?

Wrist extensor tendon tenosynovitis can initially be managed with a soft tissue brace worn for several weeks to allow swelling of the extensor tendon compartment to settle, followed by progressive physiotherapy rehabilitation exercises to restore tendon function.

However, in cases where this is not practical or where symptoms persist, an ultrasound-guided injection can be used to reduce inflammation within the affected extensor tendon sheath.

The procedure is performed by placing the ultrasound probe in a longitudinal orientation over the affected extensor tendon compartment, with one end of the probe pointing towards the fingers and the other towards the forearm.

Ultrasound gel is applied beneath the distal end of the probe to improve needle visualisation before entering the skin.

The needle is visualised running from distal to proximal through the skin into the inflamed extensor tendon compartment, and the injectate is then seen flowing through the affected extensor tendon sheath.

What to Do After Your Wrist Extensor Tendon Sheath Injection

Needle Path & Post-Injection Pain
The wrist extensor tendons and associated tendon sheaths are superficially located. Thus, there is no significant needle trauma during a wrist extensor tendon sheath injection. In some cases, the steroid may react with the subcutaneous tissues and the swelling in the tendon sheath which may cause post injection pain for 2-3 days. This is unlikely to last longer.
If this occurs, over-the-counter painkillers (as directed on the patient information leaflet) can be taken.

Wound Care & Infection Risk
Avoid exposing the needle site to public or dirty water (e.g., swimming pools, hot tubs, lakes) for 2–3 days after any ultrasound-guided injection, due to the small infection risk.

Activity Guidance
After a wrist extensor tendon sheath injection, it is advisable to avoid any significant increase in activity for 2 weeks.
This allows the anti-inflammatory properties of the steroid to work optimally.
Following this period, you should engage in a progressive program of physical therapy exercises but should not push the wrist into pain.

Follow-Up
Following a wrist extensor tendon sheath injection, please contact me immediately if you experience any difficulties.

Other Treatments for Wrist Extensor Tenosynovitis

Immobilisation for Wrist Extensor Tenosynovitis

Wrist Extensor Tenosynovitis Physical Therapy Exercises

Wrist Extensor Tenosynovitis | Evidence base

Wrist extensor tendon synovitis refers to inflammation of the extensor tendon sheaths at the dorsal wrist, commonly associated with overuse, inflammatory arthropathy, or biomechanical overload. Patients typically present with dorsal wrist pain, swelling, and pain with resisted extension. The condition may be self-limiting in mild cases, but persistent synovitis can impair function and lead to tendon degeneration if untreated. Evidence supports a conservative management approach, including activity modification, splinting, and progressive loading once symptoms allow. Ultrasound-guided corticosteroid injection into the affected tendon sheath is well supported for patients with persistent pain and swelling despite initial conservative care. Ultrasound guidance allows accurate sheath placement, confirms active synovitis, distinguishes tenosynovitis from tendinopathy or ganglion cysts, and minimises the risk of intratendinous injection. Studies suggest US-guided injections improve short-term pain relief and functional outcomes, particularly in inflammatory or proliferative synovitis, and may reduce recurrence compared with blind techniques. Repeat injections should be used cautiously due to the risk of tendon weakening, and are best reserved for clearly defined flares. Surgical intervention is rarely required and is reserved for refractory cases or underlying structural pathology. Overall, ultrasound-guided tendon sheath injection is a safe and effective option for symptom control and restoration of wrist function when appropriately selected.

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