What is the management of partial tendon lacerations?

Management of Partial Tendon Lacerations

For most partial tendon lacerations, conservative management without suturing and with early active mobilization is recommended as the primary treatment approach, especially for extensor tendon lacerations involving up to 90% of the tendon width and flexor tendon lacerations involving up to 95% of the cross-sectional area.

Assessment and Classification

• Initial evaluation should include:
  • Standard radiographs to rule out associated fractures, foreign bodies, or calcifications 1
  • Assessment of the percentage of tendon lacerated
  • Evaluation for beveling of the laceration edges
  • Determination of the injury zone (particularly important for extensor tendons)

Treatment Algorithm

Flexor Tendon Partial Lacerations

1. Non-beveled lacerations (any percentage):

   • No suturing required
   • Early active mobilization 2, 3

2. Beveled lacerations:

   • < 25% of cross-sectional area: Either excise or repair with simple interrupted suture

   • 25% of cross-sectional area: Repair with a few simple sutures

   • Early active motion regardless of repair status 2

Extensor Tendon Partial Lacerations

• Conservative management without suturing or splinting is safe for lacerations involving 55-90% of tendon width in zones II, IV, VI-VIII of fingers and zones II, IV, and V of thumb 4
• Immediate non-resistive active mobilization for 4 weeks, followed by resistive exercises 4

Rehabilitation Protocol

Phase	Focus	Duration	Activities
Initial	Pain control and protected range of motion	0-4 weeks	Non-resistive active motion exercises
Intermediate	Progressive strengthening	4-8 weeks	Begin resistive exercises
Advanced	Occupation-specific training	8-12 weeks	Functional exercises [1]

Return to Activity Guidelines

• Return to light work: 6 weeks post-injury 4
• Return to full activity criteria:
  • Complete resolution of pain
  • Full range of motion
  • Strength symmetry >90% compared to uninjured side
  • Successful completion of occupation-specific functional tests 1

Follow-up Assessment

• Regular assessment at 2,6, and 12 weeks to evaluate:
  • Pain levels
  • Range of motion
  • Functional improvement
  • Signs of complications 1

Evidence Analysis and Clinical Considerations

The most recent systematic review (2023) confirms that non-operative management of selected partial extensor tendon lacerations is safe, with similar outcomes in pinch and grip strength and return to work time compared to surgical repair 5. Importantly, adverse outcomes were reported only in patients undergoing surgical repair, not in those managed conservatively.

Multiple studies dating back to the 1970s and 1980s consistently demonstrate excellent outcomes with conservative management. A 1986 study using a canine model showed that suturing partial flexor tendon lacerations actually had statistically significant adverse effects on breaking strength, stiffness, and energy absorption compared to non-repair with early mobilization 6.

Clinical studies report excellent functional outcomes in 23 out of 26 patients (88%) with partial tendon lacerations managed without suturing and with early mobilization 2, and in 16 out of 17 patients (94%) using the same approach 3.

Potential Complications and Monitoring

• Watch for:
  • Tendon rupture (rare with proper patient selection)
  • Triggering (may resolve spontaneously) 2
  • Infection
  • Complex regional pain syndrome 4

Special Considerations

• Patient cooperation is essential for successful conservative management 3
• Avoid complete immobilization as it leads to poorer outcomes 1, 6
• Consider surgical referral if no improvement occurs after 6-8 weeks of conservative treatment 1