Article by Dr Manasa S, B.A.M.S
Tendons are bands of tissue that connect muscles to bones. Extensor tendons are found just under the skin of the hand or the top of the feet. In the hand, they connect bones to muscles in the back and help in straightening the fingers and thumb. In the feet, they connect the bones of the toes to the muscles in the front of the legs. Extensor tendinitis is an inflammation of these tendons and many factors can cause inflammation. In this article we will delve into the details of its causes, symptoms, and management.
Causes of Extensor Tendinitis
Extensor tendinitis arises from repetitive motions or activities that place prolonged strain on the extensor tendons in the hands and feet. Over time, this wear and tear can lead to irritation, causing the tendons to swell and become inflamed, resulting in pain and reduced mobility.
Common activities and factors contributing to extensor tendinitis include:
– Occupational demands: Jobs requiring prolonged standing or repetitive hand movements.
– Physical activities: Gardening, landscaping, scrubbing, woodworking, and painting.
– Sports injuries: Overuse of hands or feet in sports can strain the extensor tendons.
– Repetitive motions: Typing on a keyboard or any similar activity.
– Footwear: Shoes that fit poorly or are too tight can aggravate foot tendons.
– Parental activities: Repeated lifting and breastfeeding can strain wrist tendons in new mothers.
Specific Causes of Extensor Tendinitis in the Hands and Feet:
Extensor tendinitis typically results from repetitive strain on the muscles, bones, and tendons. The specific causes vary for the hands and feet:
- In the Hands
Common causes of extensor tendinitis in the hands involve repetitive motions and strain on the hand and wrist tendons, including:
– Extended or high-impact typing: Prolonged use of a non-ergonomic keyboard.
– Intense musical instrument practice: Overuse from playing instruments like the piano or guitar.
– Sports activities: Regularly playing sports that stress the hands and wrists, such as baseball or racquetball.
– Mallet finger injuries: This specific injury occurs when the fingertip is struck, often by a ball, damaging the tendon along the top of the finger.
- In the Feet
The main causes of extensor tendinitis in the feet are related to prolonged pressure and improper footwear:
– Prolonged standing or walking: Spending extended periods on the feet.
– Tight or unsuitable footwear: Wearing shoes that are either too tight or inappropriate for physical activity.
– Inadequate sports footwear: Using shoes that lack proper support for specific sports or activities.
– Although less common, sudden twisting injuries—such as catching yourself after a fall or tripping—can also trigger extensor tendinitis.
Signs and Symptoms of Extensor Tendinitis:
Extensor tendinitis typically presents with symptoms that may vary depending on whether it affects the hands or feet. The most common symptom, regardless of location, is pain.
Key Symptoms
– Pain: Pain along the length of the affected tendon or in the surrounding area. In the feet, pain is generally felt on the top of the foot, close to the center, while in the hands, it tends to occur on the top of the hand. Pain intensifies with movement or activity.
– Stiffness: Reduced flexibility and stiffness in the affected joint, making movement challenging.
– Swelling: Visible swelling around the inflamed tendon area, often accompanied by warmth.
– Redness and warmth: Red, inflamed skin around the affected tendon, often warm to the touch.
– Crepitus: A crunchy sensation or sound when moving the affected tendon.
– Discoloration: Slight changes in skin color near the injury site.
These symptoms tend to worsen with continued activity and may persist or progress if not adequately addressed.
Who is at Risk for Extensor Tendinitis?
Extensor tendinitis can affect individuals of all ages, though certain factors increase the likelihood of developing this condition. Those who engage in repetitive hand or foot movements, either due to their occupation or hobbies, are more prone to extensor tendinitis.
Additionally, individuals with specific health conditions are at a higher risk, including:
– Autoimmune diseases (e.g., rheumatoid arthritis)
– Types of arthritis (e.g., gout)
– Foot problems (e.g., osteoarthritis)
– Foot structure issues (e.g., flat feet or high arches)
– Age: People over 40, or those with naturally tight (inflexible) tendons
– Lifestyle factors: Smokers or those who use tobacco products
Diagnosis and Testing for Extensor Tendinitis
To diagnose extensor tendinitis, your healthcare provider will:
– Conduct a thorough physical examination.
– Discuss your symptoms and review affected areas.
– Examine your hand or foot for visible signs.
– Palpate (press) specific areas to assess swelling, tenderness, and pain severity.
– Request you to perform specific movements to evaluate: Range of motion, Strength and Pain severity
If further assessment is needed for tendon tears or other internal damage, your provider may recommend imaging tests such as:
– X-rays
– Musculoskeletal Ultrasound (MSK-US)
– CT (Computed Tomography) Scan or MRI (Magnetic Resonance Imaging)
These tests provide a clearer view of any structural damage and help guide an effective treatment plan.
Management and Treatment of Extensor Tendinitis
Treatment Options
Extensor tendinitis is often manageable with home remedies and over-the-counter medications. Key treatment steps include:
RICE Method:
– Rest: Avoid activities that strain the tendons; limit hand or foot use until healing.
– Ice: Apply a cold compress for 15 minutes, four times daily.
– Compression: Wrap the affected area with an elastic bandage to minimize swelling.
– Elevation: Keep the hand or foot elevated above heart level as often as possible.
Pain Relief: Over-the-counter NSAIDs, such as aspirin or ibuprofen, can help reduce pain and inflammation (consult your provider if taking for more than 10 days).
If symptoms persist after several weeks, further treatments may be recommended:
– Corticosteroid Injections: Reduce inflammation and relieve pain.
– Physical Therapy: Includes stretching and range-of-motion exercises to strengthen and relieve tension in affected tendons.
Surgery is rarely needed and considered only if other treatments are ineffective.
Duration of Recovery
Recovery time depends on the extent of tendon irritation and individual response to rest. Most people start to feel relief after resting and avoiding aggravating activities, with full recovery typically taking several weeks to a few months. A healthcare provider can offer guidance on the expected recovery timeline based on your specific condition.
Preventive Measures
To reduce the risk of extensor tendinitis:
During Physical Activities:
– Use appropriate protective gear.
– Avoid “playing through the pain.”
– Allow for adequate rest and recovery time.
– Warm up and stretch before, and cool down after, exercise.
– Consider wrist or ankle support if tendons feel sore.
General Safety Tips:
– Keep spaces free of tripping hazards.
– Use proper tools to reach high places; avoid standing on unstable surfaces.
– Use mobility aids, like canes or walkers, if you have balance concerns or an increased fall risk.
Following these preventive steps can help maintain tendon health and reduce the likelihood of recurring injuries.
When to Seek Medical Attention for Extensor Tendinitis
Contact Your Healthcare Provider If:
– Pain or swelling worsens after a few days.
– You experience limited movement in your hand or foot.
Seek Emergency Care If You Have:
– Severe, unrelenting pain.
– Increasing swelling.
– Discoloration around the affected area.
– Complete inability to move your hand or foot.
Prompt attention can help prevent further complications and promote effective healing.
Outlook and Prognosis for Extensor Tendinitis
With proper care, extensor tendinitis generally heals fully and does not lead to long-term effects on health or daily activities. Most individuals can maintain regular activities, such as walking, as long as they avoid overstraining the affected tendons.
In cases where work or hobbies contributed to the tendinitis, temporary adjustments or rest may be necessary to prevent aggravation. Before returning to high-impact activities like running or strenuous exercise, consult with a healthcare provider to avoid further tendon injury or complications.
Related Studies and Research
A ten-year population-based study regarding the incidence of acute traumatic tendon injuries showed –
– An incidence rate of 33.2 injuries per 100,000 person years
– Highest incidence of injury – in between 20-29 years of age
– There was significant association between injury rate and age
– Males had higher incidence than females
– Majority cases involved single tendon
– Extensor tendon injuries occur more frequently than flexor tendons
– Typically, extensor tendon injuries involved zone three of index finger
– Work-related injuries accounted for 24.9% of acute traumatic tendon injuries
– The most common groups work-related injuries occurred in construction and extraction (44.2%) followed by food preparation and serving related occupations – 14.4% and transportation and material moving operations – 12.5%
Ayurveda Understanding
Though there is no disease entity explained in Ayurveda which can be directly correlated with ‘Extensor Tendinitis’, the symptoms reflect this condition to be understood on the lines of ‘Vata Vyadhi’. The causes of Extensor Tendinitis too are ‘vata aggravating ones’.
The disease can also be understood on the lines of the below mentioned conditions happening in hands and feet –
– Vatarakta
– Sandhigata Vata
– Mamsagata Vata
– Snayugata Vata
– Shotha
– Amavata
The treatment principles too will be the same as of the above said conditions.
Related Reading – Extensor Tendinitis – ‘Ayurveda Understanding’
