Diagnosing Wrist Tendonitis

Wrist tendonitis and tendinosis are commonly diagnosed by primary care physicians, hand surgeons, and sports medicine physicians.

See What Is the Difference Between Tendonitis, Tendinosis, and Tendinopathy?

When wrist tendonitis or other tendon problems is suspected, a doctor will take a medical history and conduct a physical examination. Medical imaging tests may be ordered in some cases.

See What to Do When a Wrist Injury Occurs

Physical Examination and Medical History

The first step in diagnosing wrist tendonitis includes conducting a physical exam and evaluating the patient's medical history.

• A physical examination is a process where a doctor typically checks for:
  • Tenderness on palpating (gently applying pressure) the wrist, hand, and forearm
  • Flexibility and range of motion of the wrist and forearm
  • Swelling and/or bruising in the wrist, hand, and/or forearm
• Review of medical history includes the doctor asking about:
  • The onset of pain and other symptoms
  • Type, nature, and duration of pain
  • Trauma or injury to the wrist area
  • The occurrence of muscle spasms or cramps in the forearm or hand
  • Decreased strength in the hand

Sometimes, a doctor may also perform specialized clinical tests as a part of the physical exam.

Clinical Tests for Wrist Tendonitis

Specialized manual tests check the function and stability of the wrist’s tendons and can help a doctor determine the location and severity of wrist tendonitis.

Common clinical tests for evaluating wrist tendonitis are:

• Wrist extension tests. These tests check for inflammation in the extensor tendons of the wrist and include:
  • Test for extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) tendons. This test involves the following steps:
    • The patient’s forearm is placed on a table in the palm-down position, and the elbow bent at 90 degrees.
    • The doctor supports the patient’s forearm. The patient is asked to make a fist and bend the wrist backward (extension).
    • Simultaneously, the doctor gently presses down on the back of the patient’s hand to provide resistance.
  • Test for extensor carpi ulnaris (ECU) tendon. This test involves the following steps:
    • The patient’s forearm is placed on a table in the palm-down position.
    • The doctor supports the forearm while the patient is asked to make a fist and bend the wrist backward.
    • Simultaneously, the doctor gently pushes the little finger side of the fist toward the thumb side to provide resistance.
    • >If wrist pain is felt when resistance is applied it indicates a tendon is inflamed.
• Wrist flexion tests. These tests check for inflammation in the flexor tendons of the wrist and include:
  • Test for flexor carpi ulnaris (FCU) tendon. This test involves the following steps:
    • The patient’s forearm is placed on a table in the palm-up position.
    • The wrist is bent up and toward the little finger.
    • The patient is then asked to hold the wrist up while the doctor applies resistance
  • Test for flexor carpi radialis (FCR) tendon. This test involves the following steps:
    • The patient’s forearm is placed on a table in the palm-up position.
    • The wrist is bent up.
    • The patient is then asked to hold the wrist up while the doctor applies resistance. If wrist pain is felt when resistance is applied it indicates a tendon is inflamed.
• Finkelstein’s test. This test includes making a fist with the fingers covering the thumb and then bending the wrist toward the little finger. Pain on the thumb side of the wrist is a positive indication of tendonitis in the wrist area.

See Soft Tissues of the Wrist

In some cases, medical imaging tests may be ordered to confirm wrist tendonitis.

Medical Imaging Tests for Wrist Tendonitis

Common tests used to evaluate and confirm tendon injuries in the wrist are ultrasound and/or magnetic resonance imaging (MRI).¹Weinreb JH, Sheth C, Apostolakos J, et al. Tendon structure, disease, and imaging. Muscles Ligaments Tendons J. 2014;4(1):66-73.

• An ultrasound can be performed at different angles of the wrist. This test provides good details of the affected tendons and their surrounding soft tissues.
• An MRI of the wrist is usually ordered if the doctor wants to evaluate the tendons as well as their surrounding structures, such as bones and cartilage.

See Guide to Wrist Anatomy

Degeneration of a tendon resulting in tendinosis can also be diagnosed using the same clinical and medical imaging tests used for tendonitis.