From the Guidelines
Management of extensor pollicis longus (EPL) tendonitis begins with conservative measures including rest, immobilization with a thumb spica splint for 4-6 weeks, ice application for 15-20 minutes several times daily, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-800mg three times daily or naproxen 500mg twice daily.
Key Considerations
- Patients should be encouraged to reduce activity to decrease repetitive loading of the damaged tendon, as stated in 1.
- Relative rest and reduced activity prevent further damage and promote healing and pain relief, as recommended in 1.
- Cryotherapy provides acute relief of tendinopathy pain and its use is widely accepted, with repeated applications of melting ice water through a wet towel for 10-minute periods being most effective, as noted in 1.
- Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes, as discussed in 1.
Treatment Options
- Physical therapy focusing on gentle stretching and strengthening exercises should be initiated after the acute phase subsides.
- Corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) may be considered for persistent symptoms, though these should be limited due to risk of tendon weakening.
- For EPL rupture, surgical intervention is typically necessary, with primary repair being preferred when possible, but if delayed diagnosis occurs or there is insufficient viable tendon, tendon grafting (often using palmaris longus) or tendon transfer (commonly extensor indicis proprius) may be required, as generally accepted in practice.
Post-Surgical Rehabilitation
- Post-surgical rehabilitation includes protected immobilization for 4-6 weeks followed by gradual range of motion and strengthening exercises.
- EPL problems often result from repetitive microtrauma, anatomical factors like friction at Lister's tubercle, or systemic conditions such as rheumatoid arthritis, making proper diagnosis and addressing underlying causes essential for successful management, as discussed in 1 and 1.
From the Research
Management of Extensor Pollicis Longus Tendonitis or Rupture
The management of extensor pollicis longus (EPL) tendonitis or rupture involves various treatment options, including:
- Open injuries requiring tendon reconstruction by suture followed by immobilization and adequate aftercare, depending on the zone of injury 2
- Closed chronic ruptures of the EPL tendon may require a tendon transfer or a tendon autograft 2
- Reconstruction strategies after rupture of the EPL tendon, including extensor indicis proprius (EIP) transfer, which is contraindicated in certain cases 3
- Other transfers or grafts should be considered if the EIP is not available or if the patient has significant tendon attrition 3
Treatment Options
Treatment options for EPL tendonitis or rupture include:
- EPL tendon decompression to prevent rupture in patients with prodromal symptoms, such as tenderness over the EPL tendon and pain with thumb motion 4
- Primary repair, tendon grafting, and tendon transfer techniques for reconstruction, with generally good outcomes 5
- Refixation of the ruptured structures in cases of extensor hood rupture at the metacarpophalangeal joint 2
Prevention
Prevention of EPL tendon rupture is possible in some cases, particularly in patients with prodromal symptoms, by: