Treatment for Puncture Injury with Extensor Digitorum Tendon Injury

Initial Assessment and Diagnosis

Diagnosis should include thorough inspection for swelling, asymmetry, and erythema of the involved tendon, along with range-of-motion testing, palpation for tenderness, and examination maneuvers that simulate tendon loading and reproduce pain, and plain radiography, ultrasonography, and MRI can be helpful if the diagnosis remains unclear, as recommended by the American Academy of Family Physicians 1

Most patients with tendon injuries (about 80%) fully recover within three to six months, and relative rest of the affected area is essential to prevent further damage and promote healing and pain relief, as stated by the American Academy of Family Physicians 1
Cryotherapy (ice) should be applied through a wet towel for 10-minute periods to provide acute pain relief, according to the American Academy of Family Physicians 1
Eccentric strengthening exercises should be implemented as they are effective for treatment of tendinopathy and may reverse degenerative changes, as recommended by the American Academy of Family Physicians 1

NSAIDs (topical or systemic) are effective for short-term pain relief but have no effect on long-term outcomes, and topical NSAIDs may have fewer systemic side effects compared to oral NSAIDs, as stated by the American Academy of Family Physicians 1
Locally injected corticosteroids may provide acute pain relief but should be used with caution as they may inhibit healing and reduce the tensile strength of the tissue, potentially predisposing to spontaneous rupture, according to the American Academy of Family Physicians 2

Therapeutic ultrasonography may decrease pain and increase the rate of collagen synthesis, but evidence for consistent benefit is weak, and extracorporeal shock wave therapy appears to be a safe, noninvasive option for pain relief but requires further research to clarify mechanisms of action, as reported by the American Academy of Family Physicians 3