Initial Treatment for Partial Thickness Tear of Common Flexor Tendon
Conservative management with relative rest, activity modification, eccentric strengthening exercises, and cryotherapy is the appropriate initial treatment for partial thickness tears of the common flexor tendon, as most cases resolve successfully without surgery. 1, 2
Diagnostic Confirmation
Before initiating treatment, confirm the diagnosis with appropriate imaging:
- MRI without contrast is the gold standard with 95% sensitivity and specificity for detecting partial tendon tears and chronic tendinopathy 1, 3
- Ultrasound is an acceptable alternative with 94% specificity but only 58% sensitivity—better at confirming the diagnosis when positive than ruling it out when negative 1, 3
Conservative Treatment Protocol (First-Line)
Activity Modification and Rest
- Implement relative rest by reducing activities that reproduce pain while maintaining some activity to prevent muscle atrophy and deconditioning 1, 3
- Avoid complete immobilization, as this leads to muscular atrophy and poor outcomes 1, 3
Pain Management
- Apply cryotherapy through a wet towel for 10-minute periods to provide short-term pain relief and reduce swelling 1, 3
- NSAIDs (oral or topical) effectively relieve tendon pain; topical formulations eliminate gastrointestinal hemorrhage risk 1
Rehabilitation Exercises
- Eccentric strengthening exercises are the cornerstone of treatment, as they reduce symptoms, increase strength, and promote tendon healing 1, 4, 3
- Tensile loading stimulates collagen production and guides normal alignment of newly formed collagen fibers 1, 3
- Deep transverse friction massage may help reduce pain 4, 3
- Stretching exercises are widely accepted as beneficial 1
Critical Pitfalls to Avoid
Corticosteroid Injections
Do NOT inject corticosteroids directly into the tendon substance, as they may inhibit healing, reduce tensile strength, and predispose to spontaneous rupture 1, 4, 3. While peritendinous injections may provide short-term pain relief, they do not alter long-term outcomes and should be used with caution 1.
Complete Immobilization
Avoid complete immobilization as it causes muscular atrophy and deconditioning 1, 4, 3
When to Consider Surgical Intervention
- Surgery should be considered if conservative management fails after 3-6 months of appropriate treatment 4, 3
- High-level athletes with complete rupture may warrant earlier surgical consideration 2
- Surgical options include tendon debridement and reattachment as the gold standard 2
Expected Outcomes with Conservative Management
Conservative treatment of partial flexor tendon injuries has demonstrated excellent results in the literature, with 93% excellent outcomes and 7% good outcomes when appropriate guidelines are followed 5. Recent meta-analysis confirms that conservative treatment offers solid long-term prognosis with very few complications 6.