Treatment of Ulnar Tendonitis

Initial Conservative Treatment

The American College of Physicians recommends beginning with 3-6 months of conservative management, including relative rest, NSAIDs, cryotherapy, and eccentric strengthening exercises, before considering invasive interventions 1
Reduce repetitive strain on the damaged tendon while maintaining some activity to prevent muscle atrophy 1
Avoid complete immobilization as it leads to muscular atrophy and deconditioning 1, 2
NSAIDs, either oral or topical, are recommended for short-term pain relief, though they do not affect long-term outcomes 1, 3
Topical NSAIDs are preferable due to fewer systemic side effects, particularly elimination of gastrointestinal hemorrhage risk 1, 3
Cryotherapy through a wet towel for 10-minute periods provides effective acute pain relief 1, 3
Eccentric strengthening exercises are the cornerstone of treatment and can reverse degenerative changes in the tendon 1
Deep friction massage may provide additional benefit 4

Corticosteroid injections may be more effective than oral NSAIDs for pain relief in the acute phase, but do not improve long-term outcomes 1, 4
Critical pitfall: Avoid direct injection into the tendon substance as this inhibits healing, reduces tensile strength, and may predispose to rupture 1, 2, 3
Extracorporeal shock wave therapy appears safe and effective for chronic tendinopathies, though costly 1, 3
Ultrasonotherapy may decrease pain and increase collagen synthesis, though evidence is limited 1

Surgery is justified only if pain persists despite 3-6 months of well-managed conservative treatment 1, 2
Excision of abnormal tendinous tissue and longitudinal tenotomies to release areas of scarring and fibrosis 1

Approximately 80% of patients with overuse tendinopathies recover completely within 3-6 months with appropriate conservative treatment 1

Do not inject corticosteroids directly into the tendon substance 1, 2
Avoid multiple corticosteroid injections as they may weaken tendon structure despite short-term symptom relief 2
Do not proceed to surgery without an adequate 3-6 month trial of conservative treatment 1, 2
If multiple tendons are symptomatic, evaluate for underlying rheumatic disease 3