What treatment options are available for a 12-year-old with persistent hand tendinitis due to computer use, which has not improved with two months of complete rest?

Treatment for Hand Tendinitis in a 12-Year-Old

For a 12-year-old with persistent hand tendinitis from computer use that hasn't improved after two months of complete rest, a progressive rehabilitation program with eccentric strengthening exercises should be initiated as the primary treatment approach.

Initial Assessment and Management

• Hand tendinitis typically presents with localized pain that worsens with activity, and in this case, the prolonged symptoms despite rest suggest chronic tendinosis rather than acute inflammation 1
• Complete immobilization should be avoided as it can lead to muscular atrophy and deconditioning; instead, relative rest that allows activities that don't worsen pain is recommended 1
• Cryotherapy (ice therapy) should be implemented for short-term pain relief, applying ice through a wet towel for 10-minute periods 1

Primary Treatment Approach

• Eccentric strengthening exercises should form the cornerstone of treatment as they:

  • Have proven beneficial in treating tendinopathy 1
  • May reverse degenerative changes in the tendon 1
  • Stimulate collagen production and guide normal alignment of newly formed collagen fibers 1

• Stretching exercises should be incorporated alongside strengthening as they are generally helpful for tendinopathies 1

Pharmacological Management

• Short-term use of NSAIDs (nonsteroidal anti-inflammatory drugs) can provide pain relief, though they don't affect long-term outcomes 1
• Topical NSAIDs may be preferable for a child this age as they reduce pain with fewer systemic side effects 1

Adjunctive Therapies

• Orthotics or braces may be used to reinforce, unload, and protect tendons during activity, though evidence for their effectiveness is limited 1
• Therapeutic ultrasonography may be considered but has weak evidence for consistent benefit 1
• Extracorporeal shock wave therapy (ESWT) appears to be a safe, noninvasive option for pain relief in chronic tendinopathies, though it is expensive 1

When to Consider Additional Interventions

• If symptoms persist despite 3 months of conservative therapy including eccentric exercises, consider:
  • Further imaging with ultrasonography or MRI to evaluate for tendon thickening, tears, or other structural abnormalities 1
  • Referral to a hand specialist for evaluation 2
  • Corticosteroid injections may provide acute-phase pain relief but do not alter long-term outcomes and should be used cautiously in children 1

Important Considerations for Pediatric Patients

• Multiple symptomatic tendons should prompt evaluation for possible rheumatic disease 1
• For a child this age, ergonomic assessment and modification of computer use habits will be essential when returning to computer activities 3
• A gradual return to computer use with proper ergonomics, frequent breaks, and continued strengthening exercises is recommended 4

Common Pitfalls to Avoid

• Avoid prolonged complete rest/immobilization as it can lead to muscle atrophy 1
• Don't rely solely on passive treatments; active rehabilitation with eccentric exercises is crucial for long-term recovery 1
• Don't return to full computer use too quickly; implement a gradual progression with proper ergonomics 3