Treatment for Extensor Tendinitis of the Wrist
Conservative management with relative rest, eccentric strengthening exercises, and NSAIDs is the first-line treatment for extensor tendinitis of the wrist, with most patients fully recovering within 3-6 months. 1
Initial Management
- Relative rest to decrease repetitive loading on the damaged tendon while avoiding complete immobilization that could lead to muscle atrophy 1, 2
- Application of ice through a wet towel for 10-minute periods to provide short-term pain relief 2
- Local application of heat (e.g., paraffin wax, hot packs) especially before exercise can be beneficial 1
- NSAIDs for short-term pain relief, though they don't affect long-term outcomes 1, 2
- Topical NSAIDs may provide similar pain relief with fewer systemic side effects and are preferred when only a few joints are affected 1, 2
- Paracetamol (up to 4g/day) can be considered as the oral analgesic of first choice due to its efficacy and safety profile 1
Rehabilitation Protocol
- Eccentric strengthening exercises are highly recommended to reduce symptoms, increase strength, and promote tendon healing 1
- Deep transverse friction massage to reduce pain 1, 2
- Wrist splinting or orthoses to prevent deformity and provide support during activities 1, 3
- Activity modification to avoid movements that exacerbate symptoms 3
- Technique modification for athletes and manual laborers to minimize repetitive stresses on tendons 1
Advanced Interventions
- Corticosteroid injections may provide better acute pain relief than oral NSAIDs but do not alter long-term outcomes 1, 2
- Caution: peritendinous corticosteroid injections may inhibit healing and reduce tensile strength of tissue, potentially predisposing to spontaneous rupture 1
- Extracorporeal shock wave therapy (ESWT) is a safe option for chronic tendinopathies, though evidence shows mixed benefits for tendon pain 1, 2
- Therapeutic ultrasonography may decrease pain and increase collagen synthesis rate, but evidence for consistent benefit is weak 1
- Iontophoresis using corticosteroids can be effective for pain and function improvement 1
Surgical Management
- Surgery should be considered only if pain persists despite a well-managed 6-month conservative treatment trial 1, 2
- Surgical techniques typically include excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis 1
- Surgery is effective in carefully selected patients but should be reserved as a last resort 1, 4
Common Pitfalls and Considerations
- Avoid complete immobilization as it can lead to muscular atrophy and deconditioning 2
- Recognize that most tendinopathies are degenerative (tendinosis) rather than inflammatory (tendinitis) in nature 1, 5
- For athletes and those with occupational risk factors, addressing biomechanical issues and technique modification is crucial for preventing recurrence 3, 6
- In cases of extensor tendon problems associated with rheumatoid arthritis, early preventative tenosynovectomy may be indicated to prevent tendon rupture 7