Extensor Tendonitis, tendon injury of the wrist / hand

Tendons are vital structures connecting muscles to bones. In the top of the wrist and back of our hands, there are a set of tendons, called extensor tendons, which are responsible for the fine dextrous movements of the hand. They are made up of tissue called collagen and elastin, ensuring that the tendon is both tough but flexible.

Tendons need to glide smoothly, allowing the powerful contraction of the muscle to move the intended bones and joints, and hence are enclosed by synovium, a thin sheath of smooth tissue. When the tendons become irritated, their ability to glide within these compartments is restricted, causing wrist and hand pain during movement and tenderness when direct pressure is applied.

Tendon fibers can tear apart in the much the same way a rope becomes frayed. Once a tendon becomes frayed, an inflammatory response is triggered; over time an inflamed tendon can become thick, bumpy and irregular. Without proper rest and time to heal, a damaged tendon can become permanently weakened.

Disruption

Traumatic disruptions of the extensor tendons or sheath can be very serious, and very often will require tendon repair surgery. An injury to this tendon can easily make everyday tasks difficult, and may very well affect a persons performance or abilities at work. At present the results of tendon repair surgery are far from ideal, as such an invasive technique can often create excess scar tissue (adhesions) between the sheath and the tendon, restricting mobility and leading to a loss of function.

Causes

If tendons are stressed enough from excessive or unconditioned use, the sheath lining can become inflamed and movements may be painful to varying degrees as the tendons glide through the inflamed sheath. Tendinitis can be caused from overuse of a limb during an activity. For example, if a person undertakes a massive spring cleaning, the wrist is usually held in a hyperextended position as the palm exerts the pressure. The extensor tendons at the wrist level are strained and tendon sheaths become inflamed. In contrast, planting a winter garden may involve more forceful wrist flexion as small spades are repeatedly drawn toward the body. This strains the wrist flexor tendons which may become painful with wrist motion, tender to direct pressure and possibly swollen.

Prevention

Prevention of extensor tendinitis is exercised simply by not overdoing any activities that use a lot of wrist motion. (ie. cleaning, gardening, typing, filing and writing) Be careful about suddenly increasing the time spent on these activities, as your tendons are not properly conditioned to the added stress. Close attention also should be paid to the positioning of the wrist and hand - try to maintain the wrist in a neutral position and avoid any excessive flexing (bending the wrist forward) and extending (bending of the wrist backward).

Treatment of Extensor Tendinitis

If you haven't already done so, please see your physician. Treatment for Extensor Tendonitis is/are the same as treatment of the flexor tendon(s). Ultrasound is an excellent tool for reduction of swelling and pain when treating an inflamed tendon or sheath. Rest the area, apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day up to 3 days. Moist heat may be used after the acute swelling is improved and rest prevents further tendon injury. Ice will reduces initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. The application of ultrasound over the affected area will reduces swelling quickly, increase blood flow and minimize scar tissue, helping the tendon heal more quickly.

The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibres as possible - something ultrasound therapy is great at! Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal this the best you can, that way your chance of reinjury down the road is much lower than average.