How long does it take for a partial tear of the common extensor tendon at the origin, measuring 7.9 mm by 4 mm, to heal with conservative management?

Healing Time for Partial Tear of Common Extensor Tendon with Conservative Management

A partial tear of the common extensor tendon at the origin, measuring 7.9 mm by 4 mm, typically takes 3-6 months to heal with conservative management, with full functional recovery potentially requiring up to 9 months in some cases.

Diagnostic Considerations

• Ultrasound (US) has moderate agreement with MRI for diagnosis and grading of common extensor tendon tears, with sensitivity, specificity, and accuracy reported at 64.52%, 85.19%, and 72.73%, respectively 1
• MRI is generally more accurate than US at correctly identifying the type of tendon tear, which helps determine the appropriate treatment plan 1
• For partial tears of the common extensor tendon, MRI findings typically include intermediate to high T2 signal within the tendon and paratendinous soft tissue edema 1

Initial Conservative Management

• The RICE protocol (relative rest, ice therapy, compression, and elevation) should be implemented immediately after injury to control pain and swelling 2
• Short-term NSAIDs are recommended for pain relief and to reduce inflammation during the acute phase 2
• Bracing or counterforce straps may help reduce strain on the injured tendon during daily activities 1

Rehabilitation Timeline

• Weeks 1-2: Focus on pain control, relative rest, and gentle range of motion exercises once acute pain subsides 2
• Weeks 2-6: Begin isometric strengthening exercises without resistance as pain allows 2
• Weeks 6-12: Gradually introduce eccentric strengthening exercises, which have proven beneficial in tendinopathies 2
• Months 3-6: Progressive loading of the tendon with continued eccentric exercises and gradual return to normal activities 2

Return to Activity Criteria

• Full return to pre-injury activities should only occur when:
  • Pain-free range of motion is achieved 2
  • Strength is restored to at least 90% of the unaffected side 2
  • Functional testing demonstrates adequate performance 2
• This typically occurs between 3-6 months, though some cases may require up to 9 months for complete healing 3

Monitoring Healing Progress

• Ultrasound follow-up can be valuable in evaluating healing or lack of healing of tendon lesions 3
• In one study of partial extensor tendon injuries treated conservatively, pain resolved after 3-9 months with full range of motion and no residual subluxation at one-year follow-up 3

Common Pitfalls to Avoid

• Returning to full activity too soon can lead to re-injury or chronic problems 2
• Neglecting eccentric strengthening exercises may lead to improper healing 2
• Overreliance on passive treatments without progression to active rehabilitation can delay recovery 1
• Corticosteroid injections should be used with caution as they may increase risk of tendon rupture 4

Special Considerations

• For older patients, focus should be on maintaining independence in activities of daily living rather than rapid return to high-level activities 2
• For refractory cases not responding to conservative management after 6 months, additional interventions may be considered, such as platelet-rich plasma injections 4
• Full thickness tears typically require surgical intervention, but partial tears generally respond well to conservative management 4, 5