From the Guidelines
Treatment for a partial tear of the common extensor tendon at the elbow should begin with conservative management, including relative rest, icing, and eccentric strengthening exercises, as this approach is effective for most patients and minimizes the risk of further injury or complications. The goal of treatment is to reduce pain and inflammation, promote healing, and improve function, with the ultimate outcome of minimizing morbidity, mortality, and improving quality of life.
Conservative Management
Conservative management is the initial treatment approach, as it is effective for about 80% of patients with overuse tendinopathies, including those with partial tears of the common extensor tendon at the elbow 1. This approach includes:
- Relative rest to decrease repetitive loading of the damaged tendon 1
- Icing for 15-20 minutes several times daily to reduce pain and inflammation
- Eccentric strengthening exercises, typically 2-3 sessions weekly for 6-8 weeks, to promote tendon healing and improve function
- Use of a counterforce brace worn just below the elbow to reduce tension on the damaged tendon
Pharmacological Interventions
For patients with persistent symptoms, pharmacological interventions may be considered, including:
- Over-the-counter NSAIDs, such as ibuprofen or naproxen, for 1-2 weeks to reduce pain and inflammation
- Corticosteroid injections, typically methylprednisolone 40mg or equivalent with lidocaine, for temporary relief, though limited to 2-3 injections due to potential tendon weakening
Surgical Intervention
Surgery is rarely needed but may be considered if symptoms persist despite 6-12 months of conservative treatment 1. Surgical techniques vary by tendinopathy location but typically include excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis.
Outcome
Most partial tears of the common extensor tendon at the elbow heal with appropriate conservative management, though complete recovery may take 3-6 months, with gradual return to normal activities as symptoms improve. The treatment approach should prioritize minimizing morbidity, mortality, and improving quality of life, with a focus on promoting tendon healing, reducing pain and inflammation, and improving function.
From the Research
Treatment Options for Partial Tear of the Common Extensor Tendon
- The standard treatment regimen for partial tears of the common extensor tendon at the elbow involves a combination of rest, physical therapy, bracing, and anti-inflammatory medications 2.
- For cases that are refractory to conservative measures, platelet-rich plasma (PRP) has been shown to be effective 2, 3.
- In cases of full-thickness tears, surgery has been the traditional treatment option, but recent studies suggest that microfragmented adipose transfer 2 and injection of an allodermal matrix and leukocyte-rich PRP mixture 4 may be promising alternatives.
- Ultrasound examination can be used to diagnose and monitor the healing of partial tears of the common extensor tendon 5.
- Corticosteroid injections may be a contributory cause of tendon rupture, and PRP appears to enable biological healing of the lesion, whereas corticosteroids provide short-term, symptomatic relief but result in tendon degeneration 3.
Specific Treatment Approaches
- Microfragmented adipose transfer has been shown to promote complete bridging and remodeling of full-thickness common extensor tendon tears 2.
- Injection of an allodermal matrix and leukocyte-rich PRP mixture can enhance tendon integrity and improve functional status in cases of recalcitrant lateral epicondylitis 4.
- PRP injection can improve clinical and ultrasonographic outcomes in patients with recalcitrant lateral epicondylitis, including reduced pain and improved tendon morphology 3.
- Surgical reconstruction of the extensor origin with suture anchor can be an effective treatment option for complete rupture of the common extensor origin 6.