Extensor 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