What is the treatment for a surface tendon tear?

Treatment for Surface Tendon Tear

Surface tendon tears should be managed with conservative treatment for 3-6 months, including relative rest, ice therapy, NSAIDs, and eccentric strengthening exercises, before considering surgical intervention. 1, 2, 3

First-Line Conservative Management (3-6 Months)

Activity Modification and Rest

• Implement relative rest by avoiding activities that worsen pain while maintaining some activity to prevent muscle atrophy and deconditioning 1, 2
• Complete immobilization should be avoided as it leads to muscular atrophy 3
• Technique modification is essential for athletes and manual laborers to minimize repetitive stresses on the affected tendon 1

Pain Management

• Apply ice therapy through a wet towel for 10-minute periods to provide short-term pain relief, reduce swelling, and blunt inflammatory response 1, 2, 3
• Use oral or topical NSAIDs for acute phase pain relief, with topical formulations preferred to eliminate gastrointestinal hemorrhage risk 1, 2

Rehabilitation Protocol

• Eccentric strengthening exercises are the cornerstone of treatment as they stimulate collagen production and guide normal alignment of newly formed collagen fibers 1, 2, 3
• Tensile loading through controlled exercises promotes tendon healing and is essential for recovery from partial tears 1, 3
• Incorporate stretching exercises, which are widely accepted for tendon rehabilitation 1
• Deep transverse friction massage can be added to reduce pain, particularly when combined with eccentric exercises 1, 3

Second-Line Conservative Options

Injections (Use with Caution)

• Avoid corticosteroid injections directly into tendon substance as they inhibit healing, reduce tensile strength, and may predispose to spontaneous rupture 3
• Corticosteroid injections may provide better acute pain relief than NSAIDs but do not alter long-term outcomes 1, 2
• Platelet-rich plasma (PRP) injections have shown significant improvements in pain scores for partial thickness tears 4

Adjunctive Therapies

• Tennis elbow bands or bracing can help reinforce, unload, and protect tendons during activity, though supporting data is limited 1
• Therapeutic ultrasonography may decrease pain and increase collagen synthesis, but evidence for consistent benefit is weak 1
• Extracorporeal shock wave therapy (ESWT) appears safe and effective but requires further research 1

Surgical Management

Indications for Surgery

• Refer to orthopedic surgery if pain persists despite 3-6 months of well-managed conservative treatment 1, 2, 3
• High-grade partial tears may require earlier surgical consideration 3

Surgical Technique

• Surgical procedures typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 1
• For complete tears, repair involves high-strength sutures placed in running locking fashion, secured with either transosseous bone tunnels or suture anchors 5

Expected Outcomes and Clinical Pearls

• Approximately 80% of patients fully recover within 3-6 months with appropriate conservative treatment 1, 2
• Tendon healing occurs in three overlapping phases: inflammation, proliferation, and remodeling 6, 7
• These are degenerative tendinopathies (tendinosis), not inflammatory conditions, despite common terminology 2
• MRI is the gold standard for evaluating tendon tears with 95% sensitivity and specificity 3

Critical Pitfalls to Avoid

• Do not inject corticosteroids directly into tendon substance due to rupture risk 3
• Do not completely immobilize the affected area as this causes muscle atrophy 3
• Do not proceed to surgery before completing a full 3-6 month trial of conservative management 1, 2, 3
• Ensure the patient actually modifies or stops the aggravating activity, or the condition will not resolve 2