Smoking and hormonal changes related to pregnancy or menopause are major risk factors for hand and elbow tendinopathy. At the National General Medicine Days (Journées nationales de médecine générale [JNMG 2025]), a presentation focused on the specific aspects of managing tendinitis and carpal tunnel syndrome of the hand and elbow, particularly in pregnant women.

“The most important aspect of managing tendinopathies is addressing the risk factors,” said Marc-Olivier Falcone, MD, an orthopaedic surgeon specializing in hand and shoulder surgery at Clinique Jouvenet in Paris, France, during the presentation. “This allows us to avoid the need for injections or surgery, provided we intervene early enough.”

Tendinopathy is associated with degeneration of tendon collagen, which is sometimes accompanied by secondary inflammation. In the upper limbs, it most commonly affects the elbow, with epicondylitis, also known as tennis elbow, being very frequent and distinct from epitrochleitis or golfer’s elbow. Tendinopathy often occurs alongside nerve entrapment syndromes, such as trigger finger and de Quervain tenosynovitis.

Upper-limb tendinopathy generally occurs following excessive strain on the elbow, arm, wrist, or hand.

Commonly associated with work-related activity, this musculoskeletal disorder affects 1%-3% of adults in France and represents €500 million in expenses for the national health insurance system each year.

Key Risk Factors

Smoking is a major risk factor for tendinopathy beyond repetitive movements. Falcone said, “Smoking patients with epicondylitis can stop working if they are convinced that their professional activity is the cause, but they will still have their epicondylitis as long as they do not stop smoking.”

Hormonal fluctuations are also important risk factors, as the specialist reminded us. “Pregnancy is a risk factor, as is breastfeeding, due to hyperprolactinemia.” Menopause and perimenopause also increase the risk for carpal tunnel syndrome and tenosynovitis.

Hormonal treatments used for breast and prostate cancers may also be contributing factors. “These treatments can have a significant impact on the factors that promote synovitis and lead to tendon entrapment syndromes.” Hypersynovitis is also exacerbated by other endocrine disorders, such as hypothyroidism and acromegaly.

Inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis, are also risk factors for tendinopathy. Another potential cause to consider is chondrocalcinosis, a microcrystalline disease “very common in the upper limbs” that is “very easily treated with corticosteroid injections.”

Falcone noted that a particular concern in menopausal or perimenopausal women is medial epicondylitis, or “golfer’s elbow,” said Falcone. This is medial tendinitis of the elbow, affecting the tendons that attach to the medial epicondyle and the lower end of the humerus.

Diagnosis and Treatment

Clinical examination is generally sufficient for diagnosing tendinopathy using tests to identify the location of the lesion. Further examinations, such as ultrasound and MRI, should be considered, particularly if there is doubt regarding early tendon rupture or associated lesions, unusual synovitis, or recurrence.

Therapeutic management relies on medical treatments, such as corticosteroid injections, splints, and surgical treatment. In some cases, if hormonal fluctuations are suspected to contribute to the development of tendinitis, medical treatment may be sufficient while awaiting normalization.

Pregnancy Management

Falcone discussed the clinical case of a pregnant woman with hand tendinopathy. He described the specific aspects of managing upper limb tendinopathy during pregnancy, which relies on medical treatment even in cases of axonal loss.

A 29-year-old woman experienced bilateral nocturnal tingling since the 7th month of pregnancy. She also experienced significant pain in her right wrist and thumb during lifting. These symptoms were also present during her first pregnancy and disappeared shortly after delivery.

She was diagnosed with carpal tunnel syndrome associated with De Quervain’s tenosynovitis. Caused by hormonal imbalances, “tenosynovitis is common in pregnant women.” The treatment is medical and “never surgical during pregnancy,” even in cases of severe carpal tunnel syndrome, he emphasized.

Without surgery, spontaneous improvement in neurological axonal loss does not occur, except in pregnant women.

Medical treatment relies on ultrasound-guided injections and the use of a wrist splint to treat carpal tunnel syndrome, possibly with a specific orthosis for De Quervain’s tenosynovitis. This treatment is administered when there is no axonal loss on electromyography and, in exceptional cases, in pregnant women with axonal loss.

Carpal tunnel syndrome associated with axonal loss necessitates surgery to release the median nerve. Without surgery, “there is never spontaneous improvement in neurological axonal loss, except in pregnant women.” In this situation, “improvement can be expected after childbirth.”

Nevertheless, the choice of medical treatment requires verification of recovery after childbirth, which involves a follow-up electromyogram 6 weeks postpartum. “If recovery is consistent, medical treatment continues, he said. If symptoms worsen or remain stable, surgery should be considered.”

This story was translated from Medscape’s French edition.