Management of Extensor Tendinitis

Introduction to Extensor Tendinitis

The American Academy of Family Physicians recommends beginning with 3-6 months of conservative therapy consisting of relative rest, ice therapy, eccentric strengthening exercises, and NSAIDs, as approximately 80% of patients will fully recover with this approach 1, 2

Most extensor tendinopathies are degenerative rather than inflammatory conditions and should be labeled as "tendinosus" or "tendinopathy" rather than "tendonitis," according to the American Academy of Family Physicians 2

The American Academy of Family Physicians suggests allowing continuation of activities that do not worsen pain while avoiding those that exacerbate symptoms, with the goal of relative rest 1, 3
Complete immobilization must be avoided as it causes muscular atrophy and deconditioning, as recommended by the American Academy of Family Physicians 1
Tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers, according to the American Academy of Family Physicians 1
Applying ice through a wet towel for 10-minute periods is optimal for reducing tissue metabolism, slowing release of blood and proteins from surrounding vasculature, and providing short-term pain relief, as suggested by the American Academy of Family Physicians 1, 3
Eccentric strengthening exercises are a critical component as they stimulate collagen production and guide normal alignment of newly formed collagen fibers, with evidence being strongest for Achilles and patellar tendinosis, according to the American Academy of Family Physicians 1, 3
Topical NSAIDs are preferred as they effectively relieve tendon pain while eliminating the increased risk of gastrointestinal hemorrhage associated with systemic NSAIDs, as recommended by the American Academy of Family Physicians 1, 3

Tennis elbow bands or similar braces reinforce, unload, and protect tendons during activity, and are safe, widely used, and often helpful despite limited data supporting definitive conclusions regarding effectiveness, according to the American Academy of Family Physicians 1, 3
Corticosteroid injections may be used with significant caution as they may inhibit healing and reduce tensile strength of tissue, predisposing to spontaneous rupture, and should never be injected directly into the tendon substance, as recommended by the American Academy of Family Physicians 1, 3
Extracorporeal shock wave therapy (ESWT) appears safe and effective but requires further research to clarify optimal treatment strategies, according to the American Academy of Family Physicians 1

Surgery should be reserved for patients who have failed 3-6 months of well-managed conservative treatment, as recommended by the American Academy of Family Physicians 2, 3

Complete immobilization should be avoided as it leads to muscular atrophy and deconditioning, according to the American Academy of Family Physicians 1
Corticosteroids should not be injected directly into tendon substance, as recommended by the American Academy of Family Physicians 1
Degenerative conditions should not be mislabeled as inflammatory "tendonitis" as this may lead to inappropriate treatment focus, according to the American Academy of Family Physicians 2
Patience with conservative management is warranted as most patients (80%) recover within 3-6 months with appropriate conservative treatment, as suggested by the American Academy of Family Physicians 2, 3