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Extensor tendinitis is the inflammation and irritation of extensor tendons that extend the fingers and wrist. Several tendons in the wrist connect the muscles of the hand and forearm to the bones of the hand and wrist to extend the wrist, including: extensor digitorum, extensor indicis, extensor digit minimi, abductor pollicis longus, extensor pollicis brevis, extensor carpi ulnaris, extensor carpi radialis brevis and longus. These small, rope-like extensor muscles and tendons are used for gripping, lifting, and typing. Tendinitis of the extensors can occur in certain athletes, but often occurs because of repetitive motion or injury.

Continue reading for more information on the causes, symptoms and treatment options for wrist tendinitis.

Extensor tendinitis is most often caused by an overuse repetitive strain injury (RSI) that builds up over time. If the pain is persistent, it may be a sign of a different underlying condition. Other causes and conditions that may lead to the development of extensor tendinitis include:

  • Participating in athletic activities that can strain the wrist and hand, like tennis and gymnastics. In the United States, overuse tendinitis is responsible for 25% to 50% of all sports injuries.
  • Performing repetitive activities or those of a forceful nature in a job setting such as long periods of typing, working an assembly line, or heavy lifting.
  • Experiencing a sudden or severe trauma or an accident like a fall where an individual puts their hands down to catch themselves, placing excessive pressure on their wrists.
  • Bending the fingers or wrist forward aggressively.
    Overusing the extensor tendons through sustained gripping and grasping activities.
  • Note: Patients with rheumatoid or osteoarthritis may be susceptible to extensor tendinitis.
  • Note: Older individuals are often more at risk for extensor tendinitis due to a loss of elasticity in the wrist tendons.

Tendons are designed to bend, stretch and twist, but they can get injured or inflamed from an injury or overuse. If left untreated, the inflammation can cause pain, stiffness, immobility and can even become a chronic condition.

If you have extensor tendinitis, you’re probably experiencing pain and maybe even limited movement making daily activities difficult to perform. Pain is the most common symptom patients experience. The pain may radiate and even worsen with movement of the extensors. Other symptoms include:

  • Wrist pain or tenderness directly over the extensor tendon that can radiate to the hand or forearm
  • Pain or burning sensation during activities
  • Difficulty dressing and performing activities of daily living
  • Weakness may occur as the inflammation gets worse
    Feeling of tightness or loss of motion due to discomfort
  • Swelling of the extensor tendon
  • Loss of motion at the wrist

If an individual suspects they have extensor tendinitis, the initial treatment should consist of avoiding the positions and activities that produce the pain. Depending on the cause and severity of the condition, many individuals respond to conservative at-home treatment options to reduce the pain and swelling.

A course of conservative treatment is usually recommended that would include activity modification, rest and immobilization, ice, possible splinting to minimize movement, non-steroidal medications to reduce inflammation and physical therapy treatments.

If home treatments do not alleviate the pain and symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to correct any mechanical causes of the extensor tendon irritation.

Physical therapy is a highly effective treatment for extensor tendinitis. You will work directly with a hand therapist to devise a specific treatment plan that is unique to your condition and goals. A hand therapist is an occupational therapist or physical therapist who, through advanced study and experience, specialize in treating individuals with conditions affecting the hands and upper extremity. Your individual intervention plan may include pain management, manual therapy, range-of-motion exercises, patient education, and strengthening exercises.

A hand specialist may also have advanced certification as a Certified Hand Therapist (CHT) and is educated and trained to administer interventions specifically for the hand or wrist. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis, and goal of the patient or client.

Common interventions in the treatment of Extensor Tendinitis include:

  • Manual Therapeutic Technique (MTT) hands-on care including soft tissue massage, deep friction massage, manual stretching and joint mobilization by a hand therapist to regain mobility and range of motion of the wrist and tendon.
  • Splinting fabrication of custom-made splint or fitting of prefabricated splint to rest, position and stabilize the affected area to allow for healing as well as support during functional use of hand.
  • Therapeutic Exercises (TE) includes stretching and strengthening exercises to regain range of motion and strengthen the wrist and affected muscle.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve or modify movement technique and mechanics (for example, throwing, gripping, grasping, fine motor, and lifting activities) in daily use of the involved upper extremity.
  • Modalities that can include the use of ultrasound, paraffin, electrical stimulation, ice, cold laser, and others to decrease pain and inflammation at the wrist and tendon.
  • Home program education that includes strengthening, stretching and stabilization exercises and instructions/modifications to help the person perform daily tasks and advance to the next functional level.

The goals of intervention are to identify any predisposing factors, reduce pain and inflammation, promote healing, and improve quality of life.

Other procedures that your physician may recommend and perform in addition to physical therapy that include:

  • REST and ICE
    The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
    Steroidal injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Surgery to correct underlying pathology or the cause of the extensor tendinitis
  • Splinting to rest or immobilize the wrist and extensor tendons

Prognosis

If treated properly and managed correctly, most people recover full function following a course of conservative care. This may include hand therapy, medication and/or injections.

It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Depending on the severity of the initial condition as well as the length of treatment, a progressive return may take 3-4 weeks or 3-4 months.

Prevention

It is easier to prevent extensor tendinitis than to treat it. Instruction in proper daily activities or sport performance is helpful for reducing a recurrence of tendinitis.To prevent extensor tendinitis, the physical therapists at Twin Boro also recommend that you:

  • Warm up lightly before activity to improve circulation and lubricate the muscle and tendon. Warm up should be performed to the area that will be used.
  • Stretch the tendons and muscles you will be using after your warmup prior to the activity, and after it. Do not bounce when stretching. Instead, hold the stretch for 15-20 seconds.
  • Strengthen the muscles and tendons that you need to use for your activity. A regular strengthening program three times a week will keep muscles prepared for the job you are asking them to perform.
  • Do not work through pain. Listen to your body. Avoid the “no pain, no gain” philosophy. Stop any activities that are painful to the wrist or hand.
  • Avoid overuse or repetitive motions when possible. Take regular breaks during activities that are repetitive and involve the wrists.
  • Fix poor posture patterns, such as slouching.
  • Wear a supportive brace during repetitive activities such as typing.

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I have been a customer at Twin Boro in the Hadley Center Mall, South Plainfield off and on for over a year, in the care of Brianna Patane. I am writing to commend the staff there on their friendly and helpful customer service and professional and personal approach to physical therapy. In particular I want to let you know what an asset to Twin Boro Brianna is. She is an outstanding physical therapist who provides a great exercise program to use both onsite and at home, and also utilizes deep massage to increase blood flow to the injured area, which also helps make the injured area feel better. Her friendly and professional approach to PT made my experience there more enjoyable then I ever thought PT could be, and the results and improvement to my injury were noticeable at once and were long-lasting. Not only are her PT skills top notch, but her enjoyment of working with people made it a joy to have her as my physical therapist. She is the best! Having a 41-year career myself, I know employees like Brianna do not come along every day, and my suggestion is that Twin Boro do whatever is necessary to keep this valuable employee on your staff. She is a tremendous physical therapist.

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