Is physical therapy beneficial for epicondylitis with an extensor tendon partial tear?

Physical Therapy for Epicondylitis with Extensor Tendon Partial Tear

Physical therapy is highly beneficial for epicondylitis with extensor tendon partial tear and should be considered a first-line treatment approach for 3-6 months before considering more invasive interventions. 1

Conservative Management Approach

• Eccentric strengthening exercises are strongly recommended as they stimulate collagen production and guide normal alignment of newly formed collagen fibers, which is essential for healing partial tendon tears 1
• Stretching exercises should be incorporated into the rehabilitation program as they are widely accepted for tendon rehabilitation and help improve flexibility 1
• Relative rest is crucial to prevent ongoing damage by avoiding activities that worsen pain while maintaining some activity to prevent muscle atrophy and deconditioning 1
• Ice therapy provides short-term pain relief, reduces swelling, and blunts inflammatory response during acute phases 1
• NSAIDs (oral or topical) can effectively relieve pain in the acute phase, with topical NSAIDs being preferable due to reduced risk of gastrointestinal side effects 1

Physical Therapy Benefits for Tendon Healing

• Physical therapy promotes tendon healing through controlled loading, which is essential for recovery from partial tears 2
• Deep transverse friction massage can be incorporated to reduce pain, particularly when combined with eccentric exercises 2
• Most patients with overuse tendinopathies (approximately 80%) fully recover within 3-6 months with appropriate conservative treatment including physical therapy 1
• Technique modification taught during physical therapy helps minimize repetitive stresses placed on tendons, which is crucial for preventing recurrence 1

Advanced Treatment Options

• If physical therapy alone is insufficient after 6-12 weeks, consider adding tennis elbow bands to help reinforce, unload, and protect tendons during activity 1
• Corticosteroid injections may provide short-term relief but do not improve long-term outcomes and should be used with caution as they may inhibit healing and reduce tensile strength of the tissue 1
• Extracorporeal shock wave therapy (ESWT) has shown promising results for lateral epicondylosis with partial tendon tears, with evidence of pain reduction, grip strength increase, and functional improvement 3
• In a recent study, patients receiving ESWT in addition to physical therapy showed better and faster pain reduction, grip strength increase, and functional improvement than those receiving physical therapy alone 3

When to Consider Surgery

• Surgical evaluation is warranted only if pain persists despite 3-6 months of well-managed conservative treatment including physical therapy 1
• Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 2
• The primary goal of both nonsurgical and surgical treatment is to revitalize the unhealthy tissue that produces pain 4
• For full thickness tears, newer regenerative approaches like microfragmented adipose transfer may be considered before surgery, though more research is needed 5

Important Considerations

• Lateral epicondylosis is seven to ten times more common than medial epicondylosis and involves the dominant arm 75% of the time 2
• The pathoanatomy of tennis elbow is not inflammatory but rather "angiofibroblastic tendinosis," making physical therapy more appropriate than anti-inflammatory treatments alone 4
• Activities requiring repetitive wrist extension contribute to the development of lateral epicondylosis and should be modified during the rehabilitation process 1
• MRI or ultrasound may be helpful in confirming the diagnosis and extent of the partial tear, with MRI showing high inter- and intraobserver reliability for the diagnosis of epicondylalgia 2