What is the initial management for a partial tendon laceration?

Initial Management of Partial Tendon Lacerations

For partial tendon lacerations, conservative management without suturing is the recommended initial approach, combined with early protected mobilization, regardless of the extent of the laceration (up to 90% of tendon width). 1, 2

Assessment and Diagnosis

• Perform careful examination to determine:

  • Percentage of tendon width involved
  • Location (zone) of injury
  • Presence of beveling or triggering
  • Functional impairment

• Use aseptic technique during examination, including:

  • Surgical gloves
  • Skin preparation with alcohol, iodine, or chlorhexidine 3

Management Protocol

Conservative Management

1. Initial Phase (0-4 weeks):

   • Early protected mobilization using a dorsal splint 2
   • Begin non-resistive active motion immediately 1
   • Pain control with NSAIDs (e.g., ibuprofen 1.2-2.4g daily or naproxen 500mg twice daily) 3
   • Avoid complete immobilization 3

2. Intermediate Phase (4-8 weeks):

   • Remove splint at 4 weeks
   • Begin resistive exercises 1, 2
   • Progressive strengthening exercises and eccentric training 3

3. Advanced Phase (8-12 weeks):

   • Occupation-specific training and functional exercises 3
   • Return to work typically after 6 weeks 1

Surgical Considerations

Surgery is generally not required for partial tendon lacerations, even when more than half the width is involved. However, surgical exploration may be necessary to:

• Trim any beveled tendon edge
• Resect involved pulleys if causing triggering
• Repair the flexor sheath if damaged 2

Evidence Analysis

The most recent and high-quality evidence strongly supports conservative management. A 2023 meta-analysis found that conservative treatment without surgical intervention for partial flexor tendon lacerations showed similar or better results compared to surgical intervention (SMD 2.020,95% CI; 1.583-2.457; P < 0.0001) 4.

Multiple studies have demonstrated excellent outcomes with conservative management:

• A 2015 study of 45 extensor tendon lacerations (55%-90% width) showed no ruptures and full range of motion at follow-up with conservative management 1
• A 2000 study of zone II flexor tendon lacerations showed 93% excellent results with conservative management 2

Monitoring and Follow-up

• Regular assessment at 2,6, and 12 weeks to evaluate:

  • Pain levels
  • Range of motion
  • Functional improvement 3

• Monitor for complications:

  • Tendon rupture (rare with conservative management)
  • Triggering (may resolve spontaneously) 5
  • Infection
  • Complex regional pain syndrome 1

Return to Activity

Full activity is permitted when the patient demonstrates:

• Complete resolution of pain
• Full range of motion
• Strength symmetry >90% compared to uninjured side
• Successful completion of occupation-specific functional tests 3

Important Caveats

• Avoid overuse of the injured area for 24 hours after initial treatment 3
• Do not suture partial tendon lacerations unless beveling is present and >25% of cross-sectional area is involved 5
• Consider referral to a specialist if no improvement occurs after 6-8 weeks of conservative treatment 3
• Surgical intervention should only be considered when conservative measures fail after 3-6 months 3