Physical Rehabilitation Medicine/Extensor Flexors


QUESTION: Hi Brian, you helped me before with figuring out that I had Dequervains.  I wore the brace and it helped.  I actually had to buy another thumb brace for my other hand because it was starting in my other thumb.  The thumbs are getting better though.  The problem I have is on the top of my hand.  I tried working(house painter) a few weeks ago while wearing the thumb brace and really felt a lot of pain on the top of my Right hand.  I think from overcompensating because I wasn't using the thumb.  Whenever I extended my fingers was when I felt pain.  

It only hurt on the top of that hand for that day.  I was mostly concerned about my thumbs.  I had found some stretches and exercises for Dequervains online.  One was to put rubber band over all the fingers and extend them out.  I did that with both hands and the next day I felt that same pain not only on the top of my Right hand but also the Left hand.  That was about a week and a half ago.  I haven't worked for over a few weeks.  I've taken off to let everything rest.  But I still feel pain on the top of my hands from doing little stuff like typing or using my fingers a little on my laptop touchpad.  After using that rubber band and hurting both hands I iced it a lot for the first few days and then after 72 hours used contrast baths.  The contrast baths seemed to help.  It lessoned the pain, especially the first couple hours after.  But I still get the pain.  

I'm gonna have to go back to work and I'm afraid it will be debilitating.  I believe it is tendonitis of the extensor tendons, as it hurts most when I extend the fingers, even just  a little. It doesn't hurt at all when I make a fist.  Saw my doctor yesterday and she suspects carpal tunnel, but I have no pain on the inside palm and no numbness or tingling.  If I did have carpal tunnel, I'm not sure if a contrast bath would relieve the pain like it is now.  She is going to an EMG to rule out carpal.  

I have had a lot of tendonitis throughout my body, which is why I suspect that it is tendonitis.  Going to see a physical therapist assistant later today for my lower body and I'll ask her opinion.  If it is tendonitis, is it normal for extensor tendons to take a long time to heal?  Is there anything I can do?   The Dr yesterday gave a me a splint for each hand/wrist but it was too small.  The tightness caused the top of the hand to hurt even more.   

I appreciate any advice you have.  I apologize for the long post, but I'm pretty stressed out because this is affecting my career and life.  

Thank you!

ANSWER: Ok here you're right on track.  Tendonitis of the extensor digitorum communis or the "common finger extensors".  Scrap the contrast baths, ice, and definitely rubber band exercise.  If anything go get a paraffin bath and use if a few times per day.  Tendons are very avascular and heat will increase blood flow to them.  That's a bonus though but if you can swing the $40 then get one.

Treatment:  Rest.  Plus you don't have carpal tunnel.  Skip the EMG and save your co-pay.  Tell her you don't want it, can't afford it, whatever.  The treatment I would give you if you showed up in a clinic with those symptoms is to fabricate a forearm-based resting hand splint.  This would come up to the end of the digits and allow your fingers to rest.  Anytime you do anything with the hand you are using the finger extensors.  Biggest thing - modify your activity.  Don't do ANYTHING that hurts if you can avoid it.  Typing with a keyboard that is too low will aggravate it, excessive opening/closing of the hand, picking up objects with the palm down such as a pepper shaker off of a table, etc.  Rest, rest, rest and understand what will irritate it.  If you don't get relief from the above in 2-3 weeks get a prescription from your MD that says "bilateral forearm-based resting hand splints" or "evaluate and treat".  Make sure you go to a certified hand therapist (CHT) and get a custom one fabricated.  Make sure they have some experience and know what they are doing as far as fabrication of the splint, etc.  Unless you order it online from a website you probably won't find this type of splint at your local drug store.

Rest it, forget any exercise, avoid pain, and modify your activity.  They won't inject it, recommend surgery, or treat it any other way.  Some therapists will prescribe this or that therapy.  Forget it.  They are clueless.  

That help?

---------- FOLLOW-UP ----------

QUESTION: Yes that helps.  Thank you for the quick reply.  I'm with the VA and they have their own system, so getting  prescription for splint by a hand specialist is not gonna happen for me.  My Dr did put in a consult for occupational/ physical therapy.  I had success with getting relief from pain when they used ultrasound on previous tendonitis, tennis elbow.  Any chance on ultrasound relieving pain on this tendonitis, or is it just different?  That consult for therapy will take weeks though.

I only did that rubber band exercise once on the fingers.  I do use it on my thumbs to strengthen it for the Dequervains.  The only thing that has caused pain has been the laptop, i'll be more careful.  I will have to go back to work as a house painter soon to pay the bills though.  Figuring out hand movements I can do that won't hurt.

Thank you for your help, I appreciate it.
I'm going to forward your message to my Dr and see if they have any kind of hand splint.  They had given my a wrist one yesterday.

You shouldn't need one from a hand specialist.  Any MD will do.  Ultrasound uses cavitation to heat tissue which increases blood flow.  Again, same concept as paraffin heat, etc.  So it will help although the literature says very little.

Yeah skip the rubber band.  Although, once tendons are able to withstand tension pain-free it sometimes is appropriate.  But for the fingers, which are very prone to irritation and very necessary for function, I would not recommend it.  They will get a workout with daily life.  Remember on the laptop the 90 degree rule.  90 degrees at the ankle, knee, hip, and elbow.  The wrists can be straight or slightly extended.  I personally rest my forearms on the table which allows my fingers to type without straining.  Your workstation is probably set up incorrectly making healing very slow.

As far as painting, that will require some work on your part to figure out the best position.  With some rest though you may not need to adjust much.  I've had many hairdressers that have had problems with the extensors but not a painter.  DeQuairvain's is much more common in painters but tennis elbow by far is most common in the patients I've seen that paint.

Good luck and remember I'm not an don't piss any of your docs off by my opinion refuting theirs.

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Brian Neville, OTR/L, CWCE


I can answer questions about both conservative and post-operative rehabilitation for UPPER extremity injuries. These include but are not limited to: fractures, tendon repairs, tendon transfers, nerve repairs, lacerations, tenolysis procedures, TFCC injuries, repetitive motion disorders, reconstructive procedures. I have an advanced knowledge of UPPER extremity anatomy and industrial rehabilitation. I have extensive splinting skills for injuries to the upper extremity. Although not a physician or a surgeon I have worked closely with world renowned upper extremity specialists for over 10 years. I can give general information on what some of the most common upper extremity surgeries involve. I can reference those procedures as well. PLEASE DON'T ASK ME QUESTIONS ABOUT ANYTHING OTHER THAN THE NECK, SHOULDER, ARM/HAND. I'M NOT QUALIFIED AND KNOW ABSOLUTELY ZERO ABOUT BACKS/HIPS/KNEES/ANKLES/ETC. THANK YOU!!!


10+ years working closely with orthopedic and hand surgeons and their patients. I have treated patients with small lacerations to major reconstructive procedures. My knowledge base includes both conservative and post-operative rehab protocols and care for upper extremity injuries. I have treated patients all the way from day 1 post-op to return-to-work status.

Kentucky Occupational Therapy Association American Society of Hand Therapy National Nurses in Business Association Roy Matheson and Associates

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Occupational Therapist former Certified Hand Therapist (license currently inactive) Deep Physical Agent Modalities Instructor Certified Work Capacity Evaluator

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