Trigger Point Therapy - Extensor Digitorum
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.
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
More Articles About Elbow Pain
Dry Needling for Trigger Points
Certify as a Trigger Point Therapist
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