Trigger Point Therapy - Extensor Digitorum | Niel Asher Education Blogs and Articles blog

Trigger Points - Extensor Digitorum

Pain from Trigger Points in Extensor Digitorum may often be confused with Tennis Elbow

This muscle is a decelerator of the fingers, hands, and wrist through flexion. A useful assessment is the "finger flexion test". Here the client is asked to touch the pads of their fingers (i.e. fingertips) to the palmar pads - while the metacarpophalangeal joints are held straight. All fingers should touch the palmar surface.

Inability to perform this action successfully may be demonstrative of shortness in the muscle(s), with treatment likely to be required.

Trigger Points

Pain, stiffness, cramping, and weakness are the common sensations reported, with pain traveling down the forearm to the posterior part of the hand into the middle finger.

This pain may often be confused with lateral epicondylitis, C7 radiculopathy, and de Quervain’s stenosing tenosynovitis.

All the associated muscles—such as the extensor indicis, digitorum, and digiti minimi must be considered and appropriately treated when pain in the fingers is the chief complaint.

It's worth remembering that the extensor digitorum is often associated with satellite myofascial trigger points in the supinator, brachioradialis, extensor carpi radialis longus, and extensor carpi ulnaris.

Origin

Common extensor tendon from lateral epicondyle of humerus (i.e. lower lateral end of humerus).

Insertion

Dorsal surfaces of all phalanges of four fingers.

Action

Extends fingers (metacarpophalangeal and interphalangeal joints). Assists abduction (divergence) of fingers away from middle finger.

Antagonists: Flexor digitorum superficialis, flexor digitorum profundus.

Nerve

Deep radial (posterior interosseous) nerve, C6, 7, 8.

Basic Functional Movement

Example: letting go of objects held in the hand.

Extensor Digitorum Trigger Points

Referred Pain

Diffuse pain from forearm, becoming more intense in the appropriate finger (proximal metacarpal). Pain in lateral epicondyle.

Indications

Finger/hand/wrist/elbow pain, stiffness/pain/weakness (decreased grip) in fingers, tennis elbow, pain on forceful gripping, often seen in professional musicians (especially guitarists).

Causes

Computer mouse/keyboard, prolonged repetitive gripping (e.g. writing, ironing, using tools, throwing, massaging), wrist fractures or falls, casts, sports (e.g. racquet— tennis elbow, poles—skiing), occupational, playing musical instruments (e.g. piano, violin, drum), sleeping with hands curled under head/pillow.

Differential Diagnosis

Radiculopathy (cervical). Epicondylitis (tennis elbow). Osteoarthritis of fingers. De Quervain’s tenosynovitis. Mechanical wrist pain (carpals).

Connections

Brachioradialis, supinator, extensor carpi radialis longus, extensor indicis.

General Advice

Take regular breaks from typing, stretch the muscles out, change mouse every six months. Home exercise program. Self-stretch. Avoid sustained gripping.

Explore work posture/arrangement with reference to computer keyboards/ mouse.

Avoid habitual postures, such as sleeping with hands folded under head/pillow.

Common Techniques

Spray and Stretch	YES
Dry Needling	YES
Deep Stroking Massage	YES
Compression	YES
Muscle Energy	YES
Positional Release	YES
Wet Needling	YES

Links

Find a Trigger Point Professional in your area

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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.