Overuse syndromes during sports: hand & wrist

What are hand and wrist overuse syndromes?

Overload syndromes are reactions of tissues to repeated micro-stresses that temporarily exceed their resilience. Tendons, tendon sheaths, ligaments and sliding structures around the wrist and fingers are particularly affected.

• Typical sports: climbing/bouldering, tennis/padel, rowing, cross-country skiing, CrossFit/calisthenics, gymnastics, hockey, golf, throwing sports.
• Mechanisms: Repetitive gripping and holding work, strong flexion and extension movements, pronation/supination of the forearm, pressure loading in support positions.
• Course: Initially stress-dependent pain, later pain at rest, local swelling, rubbing noises (crepitation), loss of strength and function.

Anatomy briefly explained: Why the hand reacts so sensitively

The wrist connects the radius (radius) and ulna (ulna) to the carpal bones. Stability is created by a complex network of ligaments (including scapholunate [SL] and lunotriquetral) as well as the tendons of the finger flexors and extensors, which slide in tendon sheaths. On the ulnar side, the TFCC (Triangular Fibrocartilage Complex) acts as the “meniscus of the hand” and provides cushioning and stability.

• Tendons and tendon sheaths: React sensitively to friction and pressure.
• Ligaments: Secure the small joint mechanics - overloading can lead to irritation and even instability.
• Retinacula: retaining ligaments on the wrist; Too much tension can lead to tendon tightness and irritation.

Common images of overload in sports

• Tendovaginitis (tendonitis): Diffuse pain along the tendon, warm-up pain, rubbing noises.
• De Quervain tendovaginitis: irritation of the thumb tendons (APL/EPB) – typical in racket sports and carrying babies.
• Intersection syndrome: irritation where the thumb extensors run over the hand extensors; often when rowing/cross-country skiing.
• ECU tendinopathy: Overloading of the ulnar side extensor tendon (extensor carpi ulnaris), e.g. E.g. in tennis/padel, hockey.
• Flexor tendinopathy and annular ligament irritation (A2/A3) in climbers: pressure pain on the base of the finger, loss of strength in the crimp position.
• TFCC overload: ulnar wrist pain, rotational pain, “clicking” feeling, weakness under strain.
• SL ligament irritation (scapholunate): dorsoradial pain, loading instability, stabbing pain during supporting movements.
• Ganglion (joint or tendon cyst): Can arise as a result of chronic irritation and cause tenderness.
• Trigger finger (tendovaginitis stenosans): Snapping or blocking phenomenon when the finger is flexed, pronounced in the morning.

Important: Acute tears of tendons or ligaments are not considered overuse syndromes and require separate clarification.

Typical symptoms and warning signs

• Pain on exertion at a defined location, often wave-like.
• Morning stiffness, start-up pain, improvement after warming up - later also pain at rest.
• Swelling, tenderness, occasionally a rubbing noise (crepitation).
• Reduced strength when gripping, holding or turning.
• Clicking or snapping sensation (e.g. TFCC, trigger finger).
• Feelings of numbness are atypical; If neurological symptoms persist, please clarify (differential diagnosis: nerve compression syndromes).

Causes and risk factors

• Steep increase in load (e.g. new sport, more volume/intensity).
• Technical deficits, unfavorable grip technique or racket/equipment settings.
• Monotonous training stimuli without sufficient regeneration.
• Pre-existing conditions: previous irritations, instabilities, hypermobility.
• Work factors: a lot of keyboard/mouse or manual activity in addition to sports.
• Individual factors: smoking, poor sleep quality, metabolic disorders can affect tissue healing.

Diagnostics in practice

Thorough anamnesis and examination are the basis. The decisive factors are the location of the pain, the movements that trigger it and the stress profile. Specific functional tests help to narrow down the affected structures.

• Clinical tests: e.g. B. Finkelstein/Eichhoff in De Quervain, Watson test for SL problems, ECU synergy test, fovea sign in TFCC, provocative flexion/extension tests for tendons.
• Sonography: Dynamic assessment of tendons, tendon sheaths, ganglia and ECU subluxation.
• X-ray: exclusion of bony causes/misalignments; Assessment of carpal geometry.
• MRI (if the question is asked): Soft tissue diagnostics (TFCC, ligament irritations/lesions) – indication targeted and conservative.
• Differential diagnoses: arthrosis, nerve constriction syndromes, inflammatory rheumatic causes, acute partial/complete ruptures.

Conservative therapy: stepwise and cause-oriented

The aim is to restore resilience through measured stimuli, not through complete protection. Most overuse syndromes respond to consistent conservative measures.

Sport-specific information

• Climbing/bouldering: put strain on the annular ligament and flexor tendons in a gentle way; train open grip technique; Reduce volume first, then intensity; Taping of the A2 on return.
• Tennis/Padel: Check racket weight/balance and grip circumference; Address ulnar pain (ECU/TFCC) through grip technique and forearm strength training.
• Rowing/cross-country skiing: padding/grip change, technique training to reduce friction; Eccentric training of the extensor tendons in intersection syndrome.
• CrossFit/Calisthenics: modify support positions (parallettes, neutral grip), progression in handstands/push-ups; Wrist bandages only as a temporary measure.
• Hockey/Golf: Train ulnar stability (pronation/supination control), check stick adjustment and hitting technique.
• Gymnastics/Throwing: Reduce dorsal impaction pain through angle modification and shoulder/trunk control; early technology coaching.

Prevention and return to sport

Prevention means systematically building resilience and avoiding monotony. A structured return to sport protects against relapses.

• Equipment: suitable grip circumference, gloves/pads if necessary, low-friction tapes.
• Regeneration: sleep quality, micro-breaks, load changes in everyday life.

When should I seek medical advice?

• Acute click with immediate loss of strength (suspected rupture).
• Progressive swelling, redness, overheating, fever (suspected infection).
• Numbness, tingling or night pain with reduced strength (suspected nerve compression).
• Persistent pain > 4–6 weeks despite training adjustments.
• Blocking or snapping phenomena, persistent feelings of instability.

Your orthopedic contact point in Hamburg

In our practice at Dorotheenstrasse 48, 22301 Hamburg, we clarify hand overuse complaints in a structured manner. We combine sports orthopedic examination, high-resolution sonography and – if the question is clear – further imaging. The focus is on conservative, everyday and sports-related therapy.

• Individual stress and technique coaching.
• Physiotherapy and exercise programs with progression.
• Targeted use of orthoses, tapes and aids.
• Injections/regenerative options for strict indications, ultrasound-supported.

Surgical options are only considered after conservative measures have been exhausted and, if necessary, are discussed transparently and without pressure.

forecast

The outlook is good for most overuse syndromes if loads are adjusted and the tissues are gradually rebuilt. The sooner you react, the shorter the path back to sport is. Untreated irritations can become chronic - that's why a structured plan is worthwhile.