What is the treatment for extensor carpi radialis tendinitis?

Treatment of Extensor Carpi Radialis Tendinitis

The treatment of extensor carpi radialis tendinitis should follow a stepwise approach, beginning with conservative measures including relative rest, ice therapy, and eccentric strengthening exercises for 3-6 months before considering more invasive interventions. 1

Initial Conservative Management

First-Line Interventions

• Relative Rest and Activity Modification

  • Reduce activities that exacerbate pain
  • Avoid movements that stress the extensor carpi radialis tendon
  • No clear recommendations exist for the exact duration, but typically needed for several weeks 1

• Cryotherapy

  • Apply melting ice water through a wet towel for 10-minute periods
  • Provides acute relief of tendinopathy pain 1

• Eccentric Strengthening Exercises

  • Most effective exercise intervention for tendinopathy
  • May reverse degenerative changes in the tendon
  • Should be performed regularly as part of rehabilitation program 1

Pharmacological Management

• NSAIDs

  • Recommended for short-term pain relief (do not affect long-term outcomes)
  • For acute tendinitis, naproxen 500mg initially, followed by 500mg every 12 hours or 250mg every 6-8 hours as needed
  • Initial total daily dose should not exceed 1250mg, with subsequent daily doses not exceeding 1000mg 2
  • Topical NSAIDs may be effective with fewer systemic side effects 1

• Other Analgesics

  • May be used if NSAIDs are contraindicated
  • No clear evidence that NSAIDs are superior to other analgesics 1

Second-Line Interventions

• Corticosteroid Injections

  • More effective than oral NSAIDs for acute pain relief
  • Do not alter long-term outcomes
  • Should be used with caution due to potential side effects
  • Limited to 2-3 injections with 4-6 weeks between injections 1, 3

• Physical Therapy Modalities

  • Deep transverse friction massage
  • Ultrasound therapy
  • Shock wave therapy
  • Limited evidence supports these interventions, but they are commonly used 1, 3

• Orthotic Devices

  • Wrist splints or braces to reduce stress on the tendon
  • May be helpful during acute phase or for activity modification 1

Advanced Interventions for Refractory Cases

• Extracorporeal Shock Wave Therapy (ESWT)

  • Consider before surgical intervention
  • Appears effective for pain relief in chronic tendinopathies 3

• Surgical Management

  • Reserved for patients who have failed 3-6 months of well-managed conservative therapy 1, 3
  • Surgical options include:
    • Debridement of damaged portion of the tendon
    • Tenosynovectomy
    • Excision of osteophytes if present 4
  • Post-surgical recovery typically requires 3-6 months 3

Monitoring and Prognosis

• Reassess pain and function every 4-6 weeks
• Adjust treatment plan if no improvement after 8-12 weeks of consistent therapy 3
• Most patients (approximately 80%) fully recover within 3-6 months with appropriate conservative management 1

Common Pitfalls and Caveats

• Failing to provide adequate time for conservative measures to work (minimum 3 months)
• Overuse of corticosteroid injections, which can lead to tendon weakening or rupture
• Returning to full activity too quickly before adequate healing
• Neglecting eccentric strengthening exercises, which are crucial for tendon healing
• Focusing only on pain relief without addressing the underlying biomechanical issues
• Inadequate differential diagnosis - ensure other causes of wrist pain are ruled out

Remember that even with optimal management, resolution typically requires 3-6 months, and patients should be counseled accordingly about realistic expectations for recovery.