Treatment for Extensor Tendinitis of the Wrist

Initial Management

The American Academy of Family Physicians recommends relative rest to decrease repetitive loading on the damaged tendon while avoiding complete immobilization that could lead to muscle atrophy 1, 3
Application of ice through a wet towel for 10-minute periods can provide short-term pain relief 3
Local application of heat, such as paraffin wax or hot packs, especially before exercise, can be beneficial for patients with extensor tendinitis of the wrist 4
The American Academy of Family Physicians suggests NSAIDs for short-term pain relief, though they don't affect long-term outcomes 1, 3
Topical NSAIDs may provide similar pain relief with fewer systemic side effects and are preferred when only a few joints are affected, according to the Annals of the Rheumatic Diseases 4, 3
Paracetamol, up to 4g/day, can be considered as the oral analgesic of first choice due to its efficacy and safety profile, as recommended by the Annals of the Rheumatic Diseases 4

Eccentric strengthening exercises are highly recommended to reduce symptoms, increase strength, and promote tendon healing, according to the American Academy of Family Physicians 1, 5
Deep transverse friction massage can reduce pain in patients with extensor tendinitis of the wrist 5, 3
Technique modification for athletes and manual laborers to minimize repetitive stresses on tendons is crucial, as suggested by the American Academy of Family Physicians 2

Corticosteroid injections may provide better acute pain relief than oral NSAIDs but do not alter long-term outcomes, according to the American Academy of Family Physicians 7, 3
Extracorporeal shock wave therapy (ESWT) is a safe option for chronic tendinopathies, though evidence shows mixed benefits for tendon pain, as reported by the American Academy of Family Physicians 7, 3
Iontophoresis using corticosteroids can be effective for pain and function improvement in patients with extensor tendinitis of the wrist, as suggested by the American Academy of Family Physicians 5

Surgery should be considered only if pain persists despite a well-managed 6-month conservative treatment trial, according to the American Academy of Family Physicians 1, 3
Surgical techniques typically include excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis, as recommended by the American Academy of Family Physicians 1

Avoid complete immobilization as it can lead to muscular atrophy and deconditioning, as warned by Praxis Medical Insights 3
Recognize that most tendinopathies are degenerative (tendinosis) rather than inflammatory (tendinitis) in nature, according to the American Academy of Family Physicians 6