Wrist Tendinosis and Tenosynovitis in 18 year old violin player daughter

by Jackie

My daughter is 18 & healthy except for wrist pain.

She has played the violin since age 6. At 15 while playing tennis casually over the summer she developed pain in right wrist (right wrist on the left side of it (inside portion of the wrist) - pain is always in the exact same place - right smack in the middle of the wrist bone and the bone that is above the wrist bone).

Several years ago she had severe pain, saw an ortho (hand) and had a custom split of sorts made to the tune of $400 and lots of PT including cortisone patch of some kind....Advil (too much to say)...

At the time we thought the violin was involved but now that this is more chronic it does not appear that the violin is an issue.

What really seems to get this going for her is writing (she is right handed and grips the heck out of her pencil, holds it more like a lefty...we have added a rubber grip to the pencil).

She has no issues during the summer when she can practice and hour or 2 per day of violin with no pain but when school starts it acts up. Also making it act up are tennis and even throwing the ball for our dog Max.

At the moment her pain is at a 6-7 out of ten for days now.

Hand dr. can't see her until next Monday (in 5 days). Advil even 6 per day doesn't really seem to do much. Ice with a soft pack 3 times a day. Traumeel from our homeopath tried too....we can't see a consistent patern with anything helping. The pain is constant throughout the day...sometimes reducing but then it will flare again.

She is not using her arms at all in gym and is taking the week off violin to rest it, but must write and I fear the writing is a good deal of the issue...just a mom's opinion.

She had an MRI in 11/08 and it showed "Mild tendinosis of the extensor carpi radialis tendons can be seen with minimal fluid witin the extensor carpi radialis tendon sheaths noted on axial series 3 image #13.

No other tendinous abnormalities about the wrist are identified. The contents of the carpal tunnel appear normal. Everything else in the report is "normal".

I think what I worry about the most is that she will be off to college in the fall and it seems to me that we have not gotten to the "root" of why this is happening to her. (violin, handwriting, just the way she is built, hypermobile, etc???)

Dr. says she is "hypermobile"...I am not sure I truly get what that means. I have printed out your ice dipping technique and my husband is going to the store right now to buy the ice and we are going to try that.

She has another small hand brace (foam, thin, that you slip on) and she has been wearing that but we don't know if it helps at all or not really....so vague.

I was interested in the link about Magnesium as I take it for keeping heart palps in line and it does a great job. I have a quality Magnesium supplement and wonder if I should have her take one every day such as I do.

Our homeopath md does not want any kind of cortisone shot in her wrist and I can say we are shy and don't really see a long term benefit in that.

It has been recommended that she see an occupational CHT and see about the hold on the pencil (this advice from a performing arts doc.). She is a perfectionist type A personality, serious student, and her writing is very tiny and perfect...I do wonder about that but also I think an 18-year-old healthy girl is being so limited here...she looks for summer jobs based on "what won't hurt my wrist"...this is crazy to us at her young age.

Any advice is so very appreciated...I am already learning a great deal from your site..Thank you. Jackie (mom)


Joshua Answers:

Hi Jackie.

Thanks for all the details. That helps a lot.

So on the simple explanation end of things....lots of repetitive motion for the last decade. Nutrition isn't what it used to be, and teenagers aren't known for great nutrition. Possible family bloodline requiring higher magnesium intake. Type A = higher need for magnesium.

Even simpler: Muscles too tight. Connective tissue too tight. Acute and chronic Process of Inflammation.

I consider all the MRI 'findings' to be symptoms, I wouldn't really worry about all that. I like that you're interested in the ROOT of the problem.


Root #2 = Some element of nutritional deficiency playing a role.

So you're already on the right track. Have her Ice Dip a minimum of 10x/day for at least a week. Ice packing just isn't going to do it.

Get her up to her tolerance level of Magnesium ongoingly for a while, see Magnesium for Tendonitis and Magnesium Dosage. Taking 'some' isn't necessarily effective.

I'd be curious for you to try Magnesium Oil too. I have some on the way for myself, and I've seen plenty of stories of people that don't get benefit from oral intake of mag getting HUGE results from transdermal magnesium.

Cheap, worth a shot.

Get her a Vitamin D level even if you have to make your doc order it.

It's also useful to know that Inflammation Causes Vitamin B6 Deficiency.

There's a lot I can say, but let's start with that. Get her icing like crazy. The more the merrier.

I can't wait to hear what the doctor says....splint, corticosteroid shot, PT, rest, surgery, PRPT (which is worth a shot, no pun intended).

Let's see how much we can get her pain levels down in the next 4 days. We can, it'll just take some work.

More questions, more answers.

Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert

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Feb 09, 2010
PART 2 - Jackie - Follow up questions on 18-year-old daughter's wrist tendonitis
by: Jackie

Hi Joshua,

I am writing to follow-up regarding the advice you gave for our daughter (18 year old violinist with right wrist tendonitis). You suggested the ice dipping 6 days ago. We are so pleased that her pain is down from a 6-8 to 0-3, mostly around 2.

Your advice is honestly the best we've gotten and she has seen several different highly regarded hand doctors.

She originally saw a hand ortho 2 years ago and he said gangeleon cyst....NOT. The dr. was cranky that we chose to have the MRI done at a facility recommended by a performing arts dr. in Chicago. Regardless, the mri did not show any gangleon cyst but the mild tendonitis I described in my e-mail last week.

Since we thought the 1st hand dr's ego was a bit too large for us, this time around we chose to see another hand dr....same group, different doc. Unfortunately, he started off by backing up dr. #1 saying it might have been a cyst but then backed down when he realized the mri showed nothing of the sort. He then went on to say the mri facility was always missing things and their facility never does...oh dear....you can see how our confidence level was already creeping down with dr. #2.

Anyway, when he examined our daughter's hand, the pain was exactly where the mri report said the tendonitis was back in 11/08. The dr. then went on to offer a shot or therapy. We got an order for therapy 2x per week for 4 weeks.

It lists the "ECRB/ECRL Tenosynovitis" in the section of diagnosis and then the boxes checked are "joint mobilization", PROM, soft tissue mobilization; strengthening; desensitization; therapeutic modalities and ergonomic education. I called the therapy place which is a part of the ortho office. They have 5 CHT on staff.

My questions are:


Feb 09, 2010
PART 3 - Wrist Tendinosis and Tenosynovitis in 18 year old violin player daughter
by: Jackie


My questions are:

Is there any harm in continuing the ice dips?

Is there any harm in continuing the rubbing with the paper cup with the ice a couple of times per day?

She is still taking 4-6 Traumeel per day as she figures it can't hurt.

Is there any harm in starting therapy when she is better but not pain free? She doesn't want to go "backwards".

While we don't mind having her go through the therapy again, we are most interested in having the therapists show her things she can do at home...stretches, massage, etc. so that she hopefully get to the point where she does these exercise or stretches when she is writing (the biggest trigger) or playing violin (repetitive motion). Like I mentioned before, we really want to get to the bottom of the pain and then the bottom of how best to keep it gone.

I absolutely was floored that you mentioned the Magnesium since I a big believer in it as a whole. I started giving her 200 mg. Metagenics Magnesium every day since that is what I take. (she is petite, only 110 lbs.) She does take a multi-vitamin every day and I wondered about having her take the 2000 D3 that I take every day since our homeopath is a big believer in both of them. She is very afraid of the blood draw as all of our kids have vaso vagal syncope and this kid in particular sees blood and faints and throws up....every time....the dr. says she has a "sensitive composition" and she sure is a sensitive kind kid. One other thing I didn't mention is that her hands are usually cold....I'm the same way...she actually wears little gloves with the fingers cut off sometimes even in the house. I'm the same way and my sisters are also...always pretty cold in general. (Why are we living in Chicago?).

I saw the e-book you offer and wondered if you thought that would be helpful for her or if you think the short phone call would be more appropriate...we don't mind paying your fee as we know this must take up a lot of your time. Your advice so far was such a blessing and we are hoping to get this resolved for her for now and of course ultimately for the future as well. It doesn't seem to bother her much in the summer....starts right up when she is writing in school or throws the ball with the dog.

Thank you.

Feb 10, 2010
PART 4 - Joshua Comments - Wrist Tendinosis and Tenosynovitis in 18 year old violin player daughter
by: The Tendonitis Expert

Joshua Comments:

Hi Jackie!.

Ok, answers in no particular order.

1. I think a Phone Consultation could be valuable.

I think that Reversing Wrist Tendonitis ebook would be valuable.

How bout this...get a phone consult and I'll throw in the ebook. :)

2. There is NO harm from continuing to ice dip. (Some people experience dryness/redness/itchyness if the icewater strips too much oil from the skin. Use lotion, etc.)

3. Ice Massage, no harm.

4. Starting therapy is fine if still in pain -if- the therapy creates a ratio of more benefit than irritation. (This is a good topic for a voice conversation.)

5. She's taking 200mg of magnesium/day. I'd get her to her tolerance level, which is likely higher. More info on that on my Kerri's Magnesium Dosage page.

6. ABSOLUTELY have her take 2,000i.u's/day. I believe you should both be taking at least 4,000 i.u's/day.

Magnesium and Vitamin D are VITAL to health and healthy longevity. (For instance, Vitamin D -sufficiency- equals a 75% reduction in breast cancer rates.)

Check out Kerri's Vitamin D pages at www.Easy-Immune-Health.com

7. There's a finger prick blood spot test for Vitamin D, you don't need a blood draw. I can point you to one if you want. (unless that would send her over the edge...:)

8. As far as feeling cold, it's possible you family/blood line has higher needs for niacin. Niacin helps people with various issues including cold extremities and 'always feeling cold'.

No test for it, but worth it to experiment with supplementation. I'll have you talk with Kerri if you're interested, as it's not my field of expertise.

8.5. How's your thyroids? Thyroid issues can equal cold hands and tendonitis issues...
Again, Kerri. She knows about 'sub-clinical hypothyroid'.

9. I have NO idea why anybody lives in Chicago. But then, I have no idea why anybody lives east of the west coast. Crazy. Then again, I wouldn't want everyone moving here.....:)

Jun 07, 2013
ehlers danlos
by: Anonymous

make sure she doesn't have ehlers danlos syndrome


Joshua Comments:

Anonymous brings up a good point. While I wouldn't have thought of Ehlers Danlos from symptoms described, here's a question:

How flexible is your daughter, and, is she hyper-flexible? Can she touch her thumb to her wrist? When she straightens her arm, does her elbow joint go past a straight line?

Aug 05, 2020
Hope she’s okay
by: Anonymous

Hope she’s okay
Dealing with the same issue

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