Treatment for Partial Thickness Tear in Compartment 1 of the Extensor Pollicis Brevis Tendon
Conservative management is the first-line treatment for partial thickness tears of the extensor pollicis brevis tendon in compartment 1, consisting of relative rest, activity modification, and eccentric strengthening exercises. 1
Diagnostic Evaluation
- MRI without contrast is the gold standard imaging modality for evaluating tendon tears with high sensitivity (95%) and specificity (95%) 1
- Ultrasound is an appropriate alternative with high specificity (94%) but lower sensitivity (58%), making it better for confirming rather than ruling out tendinopathy 1
- For suspected tendon injuries with normal radiographs, both ultrasound and MRI without IV contrast are equally appropriate as next imaging studies 2
Conservative Management Protocol
- Implement relative rest and activity modification to reduce activities that cause pain while avoiding complete immobilization 1
- Apply cryotherapy (ice) through a wet towel for 10-minute periods to provide short-term pain relief 1
- Initiate eccentric strengthening exercises to reduce symptoms, increase strength, and promote tendon healing 1
- Incorporate tensile loading to stimulate collagen production and guide normal alignment of newly formed collagen fibers 1
- Consider deep transverse friction massage to help reduce pain 1
When to Consider Surgical Intervention
- Surgical intervention should be considered when conservative management fails after 3-6 months of appropriate treatment 1
- Significant functional limitations despite conservative management may warrant surgical evaluation 3
Important Considerations and Pitfalls
- Avoid corticosteroid injections directly into the tendon substance as they may inhibit healing, reduce tensile strength, and potentially predispose to spontaneous rupture 1
- Avoid complete immobilization to prevent muscular atrophy and deconditioning 1
- Be aware that the first extensor compartment often contains a septum (present in 62.2% of patients in one study), which may affect treatment decisions 4
- If surgical intervention becomes necessary, care must be taken to prevent tendon instability, which can occur following first compartment release procedures 5, 6
- For surgical cases, pulley reconstruction using retinacular grafts may be required if tendon instability develops following decompression surgery 5