Extensor Pollicis Longus Tendinitis

ExitCare ImageExtensor pollicis longus (EPL) tendonitis is a condition in which the EPL tendon lining (sheath) becomes inflamed. This causes pain on the thumb side (radial side) of the back of the wrist. The EPL tendon attaches the EPL muscle to the bone. The EPL muscle straightens the thumb. The tendon lining secretes a lubricant that allows the EPL to glide smoothly. When the lining becomes inflamed, the tendon can not glide smoothly, which causes pain. There are three grades of EPL tendonitis. A grade 1 strain is a mild strain, where the tendon experiences a slight pull, but no obvious tearing (microscopic tearing). There is no loss of strength, and the tendon is the correct length. Grade 2 strains are a moderate strain. There is tearing of tendon fibers within the tendon or where the tendon meets the bone or muscle. Tearing of the tendon causes the length of the whole muscle-tendon-bone unit to increase. A grade 2 injury usually results in decreased strength. A grade 3 strain is a complete rupture of the tendon.

CAUSES

  • EPL tendinitis is often an overuse injury and caused by repeated motions of the hand and wrist, due to friction of the tendon within the lining.

  • Sudden increase in activity or change in activity.

SYMPTOMS

  • Vague, diffuse pain and tenderness over the thumb side of the back of the wrist.

  • Pain that gets worse when straightening the thumb.

  • Locking, catching, or triggering of the thumb joint.

  • Limited motion of the thumb.

  • Little or no swelling, warmth, or redness of the back of the wrist.

  • Crackling sound (crepitation) when the tendon or wrist is moved or touched.

RISK INCREASES WITH:

  • Sports that involve repeated hand and wrist motions (tennis, golf, bowling).

  • Previous wrist injury.

  • Heavy labor.

  • Poor wrist strength and flexibility.

  • Failure to warm up properly before activity.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow time for adequate rest and recovery between practices and competition.

  • Maintain physical fitness:

  • Forearm, wrist, and hand flexibility.

  • Muscle strength and endurance.

  • Learn and use proper exercise technique.

PROGNOSIS

This condition is often curable within 6 weeks, if treated properly with non-surgical treatment and resting the affected area. Surgery may be advised.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated, or if not given adequate time to heal.

  • Chronic inflammation of the EPL tendon, causing pain.

  • Recurring of symptoms, especially if activity is resumed too soon.

  • Risks of surgery: infection, bleeding, injury to nerves (numbness of the thumb), continued pain, incomplete release of the tendon lining, recurring symptoms, cutting of the tendon, thumb weakness, thumb stiffness, and inability to straighten the thumb.

TREATMENT

Treatment first involves ice and medicine to reduce pain and inflammation. Stretching and strengthening exercises, along with activity modification, may be advised to reduce painful symptoms. For certain cases, a brace, splint, or taping may be advised, to reduce wrist movement during activity. Your caregiver may recommend a corticosteroid injection to reduce inflammation. If non-surgical treatment is unsuccessful, surgery may be advised to release the inflamed tendon. If the tendon is torn, it may require repair or replacement (reconstruction).

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines, (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

  • Cortisone injections reduce inflammation. However, these are used only in extreme cases, because there is a limit to the number of times they may be given. These injections may weaken muscle and tendon tissue. Anesthetics also temporarily relieve pain.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 to 4 weeks, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery: increased pain, swelling, redness, drainage of fluids, bleeding in the affected area, or signs of infection.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)