What is the treatment for a partial tear of the flexor carpi ulnaris tendon?

Treatment for Partial Tear of the Flexor Carpi Ulnaris Tendon

The optimal treatment for a partial tear of the flexor carpi ulnaris tendon is conservative management with relative rest, activity modification, and progressive rehabilitation exercises for 3-6 months before considering surgical intervention. 1, 2

Diagnostic Evaluation

• MRI is the gold standard imaging modality for evaluating tendon tears with high sensitivity (95%) and specificity (95%) 1, 2
• Ultrasound is a useful alternative with high specificity (94%) but lower sensitivity (58%), making it better for confirming rather than ruling out tendinopathy 1, 2
• Dynamic ultrasound can be particularly helpful for evaluating the flexor carpi ulnaris tendon and can detect tendinopathy, tenosynovitis, and partial tears 3

Conservative Management Protocol

• Implement relative rest and activity modification to reduce activities that cause pain while avoiding complete immobilization to prevent muscle atrophy 1, 2
• Apply cryotherapy (ice) through a wet towel for 10-minute periods to provide short-term pain relief 1, 2
• Utilize a wrist splint or brace to reduce stress on the injured tendon while allowing some movement to prevent stiffness 1, 2
• Initiate eccentric strengthening exercises after the acute phase to reduce symptoms, increase strength, and promote tendon healing 1, 2
• Incorporate tensile loading to stimulate collagen production and guide normal alignment of newly formed collagen fibers 1, 2
• Consider deep transverse friction massage to help reduce pain and promote healing 1, 2

Rehabilitation Progression

• Begin with gentle range of motion exercises once acute pain subsides 2, 4
• Progress to isometric exercises before advancing to eccentric strengthening 2, 4
• Gradually introduce sport or activity-specific exercises as healing progresses 4
• Focus on proper wrist mechanics and ergonomics to prevent recurrence 4

When to Consider Surgical Intervention

• Surgical intervention should be considered when conservative management fails after 3-6 months of appropriate treatment 1, 2
• Significant functional limitations despite conservative management may warrant surgical evaluation 2
• Acute neural compression symptoms (such as ulnar nerve compression) may require more urgent surgical intervention 5
• Surgical options may include debridement of damaged tendon tissue, repair of the tear, or in some cases, reconstruction 6, 7

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, 2
• Avoid complete immobilization to prevent muscular atrophy and deconditioning 1, 2
• Consider anatomical variants, such as ulnar nerve branches that may perforate the flexor carpi ulnaris tendon, which could complicate symptoms and treatment 8
• Athletes in sports requiring repetitive wrist motion (such as racquet sports) may require more specialized rehabilitation protocols 4

Follow-up and Monitoring

• Regular assessment of pain levels, range of motion, and functional improvement should guide progression of treatment 2
• If symptoms persist despite appropriate conservative management for 3-6 months, reassessment with imaging may be warranted to evaluate for progression of the tear 2
• For athletes or those with high physical demands, a more aggressive rehabilitation protocol may be necessary for return to full function 6, 4