Overview

Not all hand and wrist problems happen suddenly. Some develop slowly over time due to repetitive strain, overuse, or wear and tear.

Chronic ligament strains and tendinopathy (sometimes called “tendonitis” or “tendinosis”) are common causes of ongoing pain, weakness and stiffness in the wrist and hand. These conditions can interfere with your ability to grip, type, lift or play sport.

Most cases improve with accurate diagnosis, lifestyle adjustments, and a structured rehabilitation plan.

What are ligaments and tendons?

• Ligaments are strong, rope-like structures that connect bone to bone. They help keep the wrist and hand stable during movement.
• Tendons connect muscle to bone, allowing you to move your fingers, wrist and thumb.

When these tissues are repeatedly stressed, tiny microtears can form. Over time, this leads to inflammation, thickening, and weakening – known as chronic strain or tendinopathy.

Common causes

Chronic ligament and tendon problems are usually due to repeated use rather than a single accident. Typical causes include:

• Repetitive hand movements – such as typing, gripping, or manual work.
• Sports activities – like tennis, golf, climbing, or racket sports.
• Poor technique or posture during exercise or computer work.
• Weakness or stiffness in nearby muscles or joints.
• Previous injury that has not fully healed, leaving the tissue vulnerable.

These injuries are different to acute tendon and ligament injuries, which are usually caused from a specific trauma or incident of injury – you can read more about acute ligament and tendon injuries here

Who is more at risk?

You may be more likely to develop these problems if you:

• Do repetitive manual tasks or spend long hours using your hands (for example, at a computer or in manual work).
• Play racket or throwing sports that put repeated stress on the wrist.
• Have a history of acute tendon or ligament injury.
• Have joint hypermobility (naturally looser ligaments).
• Are aged over 40, when tendons naturally lose some elasticity.

Common conditions

Some of the most frequent chronic hand and wrist tendon and ligament conditions include:

• De Quervain’s tenosynovitis – inflammation of tendons on the thumb side of the wrist, often from repetitive gripping or lifting. This is commonly described as ‘baby thumb’ because it can be caused by a combination of hormonal changes after pregnancy and repetitive motions from lifting and holding a baby.
• Extensor carpi ulnaris (ECU) tendinopathy – pain and swelling on the outer wrist, common in golfers and tennis players.
• Flexor carpi radialis (FCR) tendinopathy – pain on the palm side of the wrist from overuse – often experienced by office workers and those who use computers excessively.
• TFCC (triangular fibrocartilage complex) degeneration – gradual wear of the soft tissue stabilising the wrist joint, causing deep ulnar wrist pain.
• Scapholunate ligament strain – a partial stretch of a key wrist ligament that can cause a dull ache, clicking or weakness.

Signs and symptoms

Typical symptoms develop slowly and may include:

• Dull, aching pain in the wrist or hand that worsens with activity.
• Stiffness, especially first thing in the morning or after rest.
• Swelling or thickening around the affected tendon or ligament.
• A “creaking” or “catching” sensation during movement.
• Weak grip strength or fatigue in the hand.
• Pain on specific movements (for example, lifting or twisting).

These symptoms can come and go, often flaring up with overuse and easing with rest.

How the condition is assessed and diagnosed

Your consultant will take time to:

1. Discuss your symptoms and activities – asking questions to get an understanding of how and when pain occurs.
2. Examine your wrist and hand – looking for tenderness, swelling, and movement restriction.
3. Perform specific tests, such as:
   • Finkelstein’s test for De Quervain’s tenosynovitis.
   • Resisted movement tests to pinpoint which tendon or ligament is affected.
4. Order imaging if needed, such as:
   • Ultrasound – to show tendon inflammation or tears.
   • MRI – to assess deeper soft tissues and ligaments like the TFCC Triangular fibrocartilage complex or scapholunate ligament.

Treatment options

Non-surgical management

Most chronic tendon and ligament problems can be treated successfully without surgery.

Treatment aims to reduce pain, restore strength, and prevent recurrence.

• Activity modification – reducing or changing the movements that cause pain.
• Splints or supports – to rest the affected area and prevent further irritation.
• Physiotherapy and hand therapy – targeted exercises to stretch, strengthen and rebalance muscles.
• Shockwave therapy – can stimulate healing in chronic tendinopathy.
• Ultrasound-guided injections – small doses of corticosteroid or platelet-rich plasma (PRP) may help reduce inflammation or stimulate healing.
• Ice, rest, and gradual return to activity – especially after flare-ups.
• Ergonomic advice – adjusting posture, desk set-up, or technique to reduce strain.

Surgical options

Surgery is rarely needed but may be considered if:

• Symptoms persist despite several months of non-surgical care.
• There is structural damage or instability seen on imaging.

Procedures may include:

• Tendon sheath release (for example, in De Quervain’s).
• Debridement or repair of degenerative tendon tissue.
• TFCC or ligament reconstruction if instability has developed.

Your consultant will discuss the best option for your specific condition.

Recovery and rehabilitation

Recovery times vary, but with consistent therapy:

• Most patients improve over 6 – 12 weeks of non-surgical treatment.
• If surgery is needed, rehabilitation with a hand therapist begins soon after, focusing on safe movement and gradual strengthening.
• Returning to full sport or work can take several months, depending on severity.

Regular follow-up with your consultant and therapist helps to track progress and avoid recurrence.

Prognosis and outcomes

• The majority of patients respond well to non-surgical management and return to normal activity.
• Chronic conditions can recur if the underlying cause (such as repetitive strain or poor ergonomics) isn’t addressed.
• Early treatment and guided rehabilitation offer the best long-term results.

When to seek medical advice

You should see a specialist if:

• Wrist or hand pain lasts more than 2–3 weeks despite rest.
• Pain interferes with daily activities or work.
• You experience clicking, catching, or weakness that is not improving.

Seeking early assessment and treatment helps to prevent long-term stiffness or tendon damage.

FAQs

1. How do I know if my wrist pain is from tendinopathy or arthritis?
   Tendinopathy pain usually worsens with movement and improves with rest, whereas arthritis often causes morning stiffness and swelling. A wrist specialist can confirm the cause with examination and imaging.
2. What is the best treatment for chronic wrist tendinopathy?
   The most effective treatment combines physiotherapy, activity modification, and sometimes shockwave therapy or ultrasound-guided injections. Early treatment leads to faster recovery.
3. When should I see an orthopaedic specialist for chronic wrist pain?
   If your wrist pain has lasted more than 2–3 weeks, affects daily tasks, or causes clicking or weakness, book an assessment with a hand and wrist specialist for diagnosis and treatment planning.
4. Can chronic ligament or tendon problems heal without surgery?
   Yes – most cases heal with conservative care, rest, therapy and guided exercises. Surgery is only needed if symptoms persist after several months of treatment.
5. What happens during wrist tendinopathy surgery?
   Surgery typically involves releasing or repairing damaged tendon tissue or stabilising stretched ligaments. Procedures are performed under local or regional anaesthetic, and recovery usually begins with early guided hand therapy.

References (Harvard style)

• NHS (2023). Tendonitis. Available at: https://www.nhs.uk/conditions/tendonitis/ (Accessed 10 October 2025).
• British Society for Surgery of the Hand (BSSH). De Quervain’s disease – patient information. Available at: https://www.bssh.ac.uk/patients (Accessed 10 October 2025).
• Speed, C. (2014). ‘Tendinopathy management: a review of the evidence for treatment’, Arthritis Research & Therapy, 16(229).
• Moser, T. et al. (2013). ‘Tendon and ligament injuries of the wrist: imaging update’, European Journal of Radiology, 82(10), pp. 1815–1825.