Extensor Pollicis Longus Tendinitis

Description

Extensor pollicis longus tendinitis is characterized by pain in the back of the wrist from inflammation of a tendon sheath (covering) or strain of one of the tendons to the thumb, the extensor pollicis longus (EPL). The sheath secretes a fluid that lubricates the tendon. When the sheath becomes inflamed, the tendon cannot glide smoothly. The EPL tendon is the anchor of the EPL muscle, which is important for straightening the thumb. The strain may be a grade 1 or 2 strain of the tendon. A grade 1 strain is a mild strain, a slight pull without obvious tearing (it is microscopic tendon tearing), no loss of strength, and the tendon is the correct length. A grade 2 strain is a moderate strain with tearing of tendon fibers within the substance of the tendon, or where the tendon meets the bone or muscle. The length of the whole muscle–tendon–bone unit is increased, and there is usually decreased strength. A grade 3 strain is a complete rupture of the tendon.

Common signs and symptoms

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

• Pain that is worse with straightening the thumb

• Locking, catching, or triggering of the thumb joint

• Limited motion of the thumb

• Swelling, warmth, or redness of the back of the wrist (occasionally)

• Crepitation (a crackling sound) when the tendon or wrist is moved or touched

Causes

• EPL tendinitis becomes more likely with repeated injury to the thumb muscle–tendon units and with repetitive motions of the hand and wrist from friction of the tendon within the sheath

• A sudden increase in activity or change in activity

Factors that increase risk

• Sports that involve repetitive hand and wrist motions, including tennis, golf, and bowling

• Previous wrist fracture

• Heavy labor

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