Extensor tendonitis symptoms causes and treatment methods

Tendonitis of the extensor tendons is a condition that can affect the hand and wrist, causing pain during movement and difficulty performing daily activities. This condition can occur in anyone, either due to repetitive use of the wrist, a sudden injury, or sometimes due to muscle weakness or other underlying health issues. In this article, we will discuss the causes of extensor tendonitis, its most common symptoms, accurate diagnostic methods, as well as all available treatment options, whether through medication or surgery, along with tips for prevention.

What is Extensor Tendonitis?

It is an inflammation affecting the tendons that help extend joints, raise fingers, or move the wrist.

Symptoms:

Pain
Stiffness
Weakness in the hand or wrist.

How is Extensor Tendonitis Treated with Medications?

Pain relievers: To alleviate localized pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce inflammation.
Topical creams or gels: To relieve pain and swelling.
Dietary supplements: Such as collagen and Vitamin C to strengthen tendons.

Does Extensor Tendonitis Require Surgery?

In severe or chronic cases that don't improve with medication or physical therapy, surgery may be needed to repair the tendon or remove chronic inflammation.

How Common is Extensor Tendonitis?

It is very common, especially among people who repeatedly use their hands and fingers for work, sports, or hobbies.

How Long Does Recovery Take?

The recovery time depends on the severity of the tendon inflammation.

Improvement often starts with rest and avoiding strenuous activities.
Recovery can take anywhere from a few weeks to several months before the tendons return to their normal state.

Consult your doctor for a personalized recovery timeline.

What to Expect During Recovery?

Extensor tendonitis is usually temporary.
After recovery, it should not have long-term effects on your health or ability to work or pursue hobbies.

Should You Take Time Off Work or School?

If you can perform your tasks without straining the affected hand or wrist, you don't need to take time off.

If your work or activities contributed to the tendonitis, some rest might be needed to speed up recovery.

Walking or Running with Extensor Tendonitis

Most people can walk and perform regular activities with foot tendonitis.

Just make sure to rest your body after any activity to prevent worsening the inflammation.

Stages of Extensor Tendonitis:

Stage One: Acute Inflammation
- Description: Initial inflammation due to sudden strain or repetitive motion.
- Symptoms: Mild to moderate pain with movement, slight stiffness, minor swelling, no significant weakness.
- Treatment: Short rest, ice packs, and simple pain relievers if necessary.
Stage Two: Partial Tear or Early Chronic Inflammation
- Description: Some tendon fibers are damaged due to repeated stress.
- Symptoms: Moderate pain, occasional swelling, more stiffness, mild weakness in fingers or hand.
- Treatment: Physical therapy, stretching and strengthening exercises, anti-inflammatory medication if prescribed by a doctor.
Stage Three: Chronic Inflammation or Scarring
- Description: Long-term injury or untreated partial tear leads to scar tissue around the tendon.
- Symptoms: Persistent or intermittent pain, permanent stiffness, noticeable weakness in the hand or fingers, difficulty performing fine motor movements.
- Treatment: Intensive physical therapy, sometimes steroid injections to reduce inflammation, and in severe cases, surgery to remove scar tissue.

Causes of Extensor Tendonitis:

Overuse: Repetitive movements like lifting, extending fingers, or wrist flexing put pressure on tendons, causing inflammation.
- Examples: Tennis players, baseball players, prolonged computer use, or repetitive manual work.
Direct Injuries: A fall on the hand or wrist, or a heavy blow can cause inflammation or partial tendon tear.
Weak Surrounding Muscles: Weak muscles around the joint or wrist add pressure on the extensor tendon during movement, making it more susceptible to tears or inflammation.
Aging: With age, tendons lose elasticity and strength, making even simple movements more likely to cause inflammation.
Chronic Diseases: Certain conditions weaken tendons, such as:
- Rheumatoid arthritis
- Diabetes
- Thyroid problems
Poor Posture and Wrong Movements: Sudden movements or poor posture during sports or work lead to strain on the tendon.
Nutritional Deficiency or Lack of Collagen: Tendons require proteins like collagen to stay strong. A deficiency can weaken tendons, making them more prone to inflammation.

Types of Extensor Tendonitis:

Acute Tendonitis
- Cause: Sudden movement or direct injury.
- Symptoms: Sharp pain in the back of the hand or wrist, mild swelling, temporary stiffness.
- Notes: Pain worsens with movement or pressure on the tendon.
Chronic Tendonitis
- Cause: Repetitive use of the tendon or failure to treat acute inflammation.
- Symptoms: Persistent or intermittent pain, joint stiffness, decreased movement of the hand or fingers.
- Notes: May form fibrous tissue around the tendon, reducing its flexibility.
Partial Tendon Tear
- Cause: Repeated stress or injury.
- Symptoms: Moderate pain, mild swelling or bruising, noticeable weakness in the associated muscle.
- Treatment: Physical therapy, possibly temporary tendon immobilization.
Complete Tendon Rupture
- Cause: Severe injury or excessive weakening of the tendons.
- Symptoms: Severe sudden pain, loss of ability to extend or lift fingers, significant swelling and bruising.
- Treatment: Surgery is often required to repair the tendon and restore movement.
Tendon Adhesions or Scarring
- Cause: Previous injury or surgery to the tendon.
- Symptoms: Permanent stiffness or difficulty moving the joint, pain with movement.
- Treatment: Physical therapy, stretching exercises, and sometimes surgery to remove tendon adhesions.

Who is Affected by Extensor Tendonitis?

Athletes: Players who frequently use their hands and arms, such as tennis, golf, and baseball players. Repetitive movements of lifting, pushing, or throwing can lead to extensor tendonitis.
Manual Workers: Carpenters, construction workers, or anyone involved in lifting weights or repeatedly putting pressure on the wrist.
Computer Users: People who spend long hours on the computer are at risk due to repetitive hand and wrist movements.
Older Adults: As tendons naturally weaken with age, the risk of extensor tendonitis increases.
People with Chronic Diseases: Conditions like rheumatoid arthritis or diabetes can reduce tendon flexibility or increase inflammation around them.
Anyone with a Direct Injury: A fall on the hand or wrist, or sudden violent movement, can cause inflammation or partial tendon rupture.

Symptoms of Extensor Tendonitis:

Pain in the back of the hand or fingers: Increases with movement, especially when extending fingers or lifting the hand. The intensity varies depending on the type of inflammation.
Swelling around the tendon: May be mild or moderate, sometimes accompanied by bruising if the injury is severe.
Joint or Finger Stiffness: Difficulty extending or bending fingers, often worse in the morning or after long periods of rest.
Weakness in the Hand or Fingers: Loss of ability to fully extend or lift fingers, visible in partial tears or chronic inflammation.
Clicking or Popping Sounds: A light popping noise may occur when moving the fingers due to friction between the tendon and surrounding tissue.
Tenderness When Touching the Tendon: The affected tendon becomes sensitive to touch or pressure.
Difficulty Performing Fine Movements: Tasks such as grasping small objects, writing, or using precision tools are harder, especially in severe inflammation.

How is Extensor Tendonitis Diagnosed?

Clinical Examination:
The doctor will ask about the pain location, when it starts, and what activities worsen it. They will examine joint movement and muscle strength. They'll look for signs of swelling, stiffness, or redness around the tendon.
Imaging Tests:
- Ultrasound: Shows the condition of the tendon, partial tears, or fluid accumulation.
- MRI: For assessing deep or chronic injuries, showing scarring around the tendon.
- X-rays: Usually to rule out bone or joint injuries.
Movement and Strength Tests:
Measuring the hand and fingers' ability to extend or bend against resistance. Evaluating the strength of muscles linked to the tendon.
Daily Function Test:
Evaluating tasks such as gripping objects or writing.
Medical History and Potential Causes:
Repetitive activities with the hand or wrist, previous injuries, or chronic conditions like diabetes or rheumatoid arthritis that might increase tendon weakness.

Treatment of Extensor Tendonitis with Medication

Extensor tendonitis can be treated with medications to relieve pain and reduce inflammation. It is often part of a comprehensive treatment plan that includes rest and physical therapy.

Pain Relievers
- Purpose: To relieve pain caused by inflammation.
- Examples:
  - Paracetamol for mild to moderate pain.
  - Stronger painkillers prescribed by a doctor for severe or persistent pain.
- Notes: Adhere to prescribed doses to avoid liver or stomach issues.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Purpose: To reduce inflammation, swelling, and pain.
- Examples: Ibuprofen, Naproxen, Diclofenac.
- Usage Methods:
  - Oral tablets or capsules.
  - Topical creams or gels for direct pain relief on the affected area.
- Important Tips:
  - Take with food to reduce stomach irritation.
  - Avoid long-term use without a doctor's supervision to prevent stomach and kidney problems.
Corticosteroid Injections
- Purpose: To reduce severe or chronic inflammation around the tendon.
- When Used:
  - If pain relievers and NSAIDs are ineffective.
  - For persistent pain or swelling.
- Notes:
  - Injections should be done under medical supervision.
  - Excessive injections may weaken the tendon or increase the risk of rupture.
Dietary Supplements to Promote Tendon Health
- Purpose: To strengthen tendons and speed up healing.
- Examples:
  - Collagen peptides.
  - Vitamin C and D to strengthen tissues.
  - Omega-3 fatty acids to reduce inflammation.
- Usage: Typically used alongside physical therapy for better results.

Important Tips During Medication Treatment:

✔ Do not use medications long-term without medical supervision.
✔ Medication is usually part of a comprehensive treatment plan that includes rest, physical therapy, and tendon-strengthening exercises.
✔ Pain relievers and anti-inflammatory medications relieve pain and inflammation but do not restore the tendon to its natural state or treat complete tears, which may require surgical intervention.

Treatment of Extensor Tendonitis with Surgery

Surgery is generally considered for cases that do not respond to medication or physical therapy, or for chronic inflammation that has caused severe weakness in hand movement or persistent pain. The main types of surgeries include:

Tendon Release / Tenolysis
- Description: Removing pressure on the tendon by cutting the surrounding tissue or releasing adhesions.
- When Used: For chronic inflammation causing stiffness or limited joint movement.
- Benefit: Restores tendon movement and reduces pain.
Tendon Debridement
- Description: Removing inflamed or scar tissue around the tendon.
- When Used: When there is a build-up of inflammatory or fibrous tissue reducing tendon movement.
- Benefit: Reduces pain and gradually restores tendon function.
Tendon Repair / Grafting
- Description: Reconnecting the tendon or using another tendon to replace the damaged one.
- When Used: In cases of tendon rupture or severe damage due to chronic inflammation or prior injury.
- Benefit: Restores strength and natural movement of the muscle and joint.
Adhesion Release / Scar Tissue Removal
- Description: Removing adhesions that limit tendon flexibility following a previous injury or surgery.
- When Used: For joint stiffness or hand movement weakness after long-term inflammation.
- Benefit: Improves range of motion and prevents recurrent inflammation.
Arthroscopic / Minimally Invasive Surgery
- Description: Using a camera and precision tools to remove inflammation or release the tendon without making a large incision.
- When Used: For inflammation or tendon impingement near the joint.
- Benefit: Faster healing, less pain, and smaller scars.
Tendon Realignment / Transfer
- Description: Adjusting the tendon position or transferring another tendon to strengthen joint movement if the tendon is too weak.
- When Used: For severe tears or chronic inflammation with loss of strength.
- Benefit: Restores natural wrist and finger movement.

Post-Surgery Tips:

Splinting or bracing as needed depending on the surgery type.
Gradual physical therapy exercises under specialist supervision.
Wound care to prevent infection.
Use of pain relievers and anti-inflammatory medications to reduce swelling and pain.

Prevention of Extensor Tendonitis

Avoid Repetitive Strain
- Minimize repetitive wrist and hand movements, and take short breaks to rest the tendons.
Maintain Correct Posture
- Sit or stand correctly when working or using a computer.
- Keep the wrist and hand in alignment with the arm.
Stretching and Strengthening Exercises
- Perform light wrist and finger stretches daily.
- Strengthen muscles around the wrist and forearm to support tendons.
Use Assistive Devices When Necessary
- Use splints or braces during strenuous activities to reduce tendon pressure.
- Use office or sports tools designed to minimize wrist strain.
Warm-Up Before Physical Activity
- Perform wrist and hand stretches before engaging in any physical activity to reduce the risk of injury.
Avoid Sudden or Excessive Load
- Gradually increase weight when lifting or using your hand forcefully.
- Avoid carrying heavy objects suddenly or for extended periods without rest.
Control Chronic Conditions
- Keep blood sugar, blood pressure, and cholesterol levels within healthy ranges.
- Monitor health issues that could affect the tendons.
Focus on Nutrition
- Consume foods rich in collagen, Vitamin C, and Omega-3 fatty acids to strengthen tendons.
- Drink enough water daily to maintain tissue hydration.