Management of Elbow Tendinopathy with Small Partial Thickness Tear
Begin with conservative management including relative rest, eccentric strengthening exercises, and cryotherapy for at least 3-6 months before considering surgical intervention. 1
Initial Diagnostic Imaging
Obtain plain radiographs first to evaluate for bony abnormalities including osteophyte formation at the epicondyles, degenerative joint disease, loose bodies, or fractures that may contribute to symptoms 1
MRI is the most appropriate advanced imaging when diagnosis remains unclear after clinical evaluation or for preoperative planning, as it demonstrates degenerative thickening of tendons, fibrovascular proliferation, mucoid degeneration, and can detect partial tears with 95% sensitivity and specificity 1
Ultrasonography is a reasonable alternative showing tendon thickening and heterogeneous echogenicity, though it has limited ability to detect small tears 1
Conservative Management Protocol (First-Line Treatment)
Activity Modification
- Allow continuation of activities that do not worsen pain while avoiding complete immobilization to prevent muscular atrophy and deconditioning 1
- Tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers 1
Therapeutic Exercises
- Implement eccentric strengthening exercises as the cornerstone of treatment - these have proven beneficial in multiple tendinopathies and promote tendon healing 1, 2
- Include stretching exercises, which are widely accepted and thought to be helpful 1
- Deep transverse friction massage may help reduce pain 1
Pain Management
- Apply cryotherapy (ice) for short-term pain relief through a wet towel for 10-minute periods to reduce tissue metabolism, swelling, and pain 1
- Consider short-term NSAIDs for pain relief and inflammation reduction 2
Critical Pitfall to Avoid
- Do NOT inject corticosteroids directly into the tendon substance - while they may provide short-term symptom relief, they inhibit healing, reduce tensile strength, and may predispose to spontaneous rupture 1
Advanced Conservative Options for Refractory Cases
If symptoms persist after 6-12 weeks of standard conservative management:
- Combining eccentric loading with low-energy shock wave therapy produces higher success rates than either treatment alone 2
- High-volume injection of normal saline solution can reduce pain and improve long-term function 2
- Ultrasound-guided tenotomy is a safe, minimally invasive option that decreases pain from moderate/severe to mild/occasional and improves physical function with 70% patient satisfaction and 0% complication rate 3
Surgical Intervention
- Reserve surgery for cases that fail conservative management after 3-6 months of appropriate treatment 1
- Consider earlier surgical evaluation if the patient has specific high-risk features, though these are better defined for patellar tendon (>50% thickness tears, >11.5mm tendon thickness) than elbow tendons 4