Common extensor tendon; high-grade tear

February 20, 2012, I injured my common extensor tendon playing squash. After 2 cortisone shots, and 3 weeks of physical therapy, my surgeon recommended an MRI. MRI showed a high-grade tear in the common extensor tendon. A high-grade tear means the fibers in the tendon are more than 70% torn. The surgeon recommended repair of the tendon with surgery. My elbow didn’t hurt, but it felt unstable and I didn’t have much strength in my forearm. I tried playing squash again, but the elbow just felt funny and I didn’t want to reinjure it, however, I didn’t want surgery either. So I made an appointment with another orthopedic surgeon for a 2nd opinion.

Physical Therapy to Prevent Surgery

After physical exam the surgeon recommended that I go back and do physical therapy for 3 weeks, and then he would reassess whether he felt I needed surgery. So I went back to physical therapy, 3 times a week, with physical therapy exercises at home on the days I wasn’t in the physical therapy gym. After 3 weeks, I saw the orthopedic surgeon again and had made so much progress he suggested another 3 weeks of physical therapy. I went back to physical therapy 3 times a week. Sometime around the middle of the 3 weeks, I started having pain from my elbow up to my neck. I had spasms in my bicep and my deltoid and rotator cuff hurt so badly I could not sleep at night. At the end of the 3 weeks of physical therapy I went back to the orthopedic surgeon. He said I was having pain in my shoulders and neck and spasms in my biceps it sounded like I had an injury in my neck. He did x-rays of my neck in his office, which showed bone spurs and loss of disk space at C5 C6, and that the injury was very old. I told him when I was 16, we had been in a car wreck where I hit the windshield with my head and broke. He said that looked consistent with the type of injury showing up on x-ray and how old the injury was. However, he ordered an MRI for my neck to see if there was damage of the soft tissues that couldn’t be seen on x-ray. He also gave me a Medrol dose pack, which is cortisone, and told me to come back after the MRI. I had the MRI, went back to see the orthopedic surgeon and there was nothing on the MRI. No nerve impingement, no soft tissue damage, and no reason for the pains in my shoulders and biceps. However, I had a reaction to the cortisone. I believe it’s called seratonin syndrome. My blood pressure shot up to 220/100, and my skin felt like it was crawling with ants. I just happened to be on my way to the appointment, so I decided to keep going and see what the doctor said about the reaction to the cortisone. He said I should take something my get home to lower my blood pressure and then see my regular doctor. He also set up an appointment for me with a neurologist for a nerve conduction study. The nerve conduction study is to find out if there is some nerve damage in my neck. The physical therapist had already mentioned that nerve damage could have caused the muscle to contract which led to the tear.

How Long Does it Take for High Grade Common Extensor Tear to Heal?

It takes about a 6-9 months for a tendon tear to heal because there is not much blood flow in tendons to bring the needed oxygen, new cells and nutrients to repair the tear. What happens is the tendon will just attach itself to surrounding tissues with scar tissue and eventually will tighten up and be close to “never having happened.”

Reaction to Mobic and Cortisone

When I got home I made an appointment to see my regular doctor about the cortisone reaction. He said the only thing that could be done was to let the cortisone run its course and get out of my system. He gave me blood pressure medicine to take when my blood pressure got up over 160/95. He also gave me a prescription for Ativan to help with the agitated feeling and the skin crawling sensation. He said it could take as long as 2 weeks for the symptoms to go away. It has now been a week, and although I don’t have the blood pressure spikes every day or the other symptoms, I have had episodes several times in the last week. Along with the skin crawling and feeling like something bad is about to happen. It’s a really crappy feeling and I’ll be glad when this is over. I did not go see the neurologist. I have not been doing physical therapy. I don’t want to do anything to aggravate the situation with the serotonin syndrome. Hopefully, this syndrome will stop soon and I’ll decide then whether I will keep my appointment with a neurologist. Even though the cortisone has caused a lot of problems with the serotonin syndrome, it did help with the neck pain and pain going down from my shoulder to my elbow. On my last visit to the orthopedic surgeon he said that he felt there was no need for surgery on my elbow.

Follow up: For 12 days I had blood pressure spikes every few hours – sometimes 220/100+. I took clonidine and ativan but several times would go sit in the parking lot of the ER hoping my blood pressure would go down. On the 10th day, I had tremors so badly I went into the ER. It has been 14 days now and the spikes have finally stopped. However, the slight tremors and muscle spasms are still going on. But not nearly as bad.

Cortisone and Mobic Warning

So as a warning to anyone who is taking cortisone shots, or taking Medrol dose pack, cortisone and Mobic can be very dangerous.


  1. I have had sporadic issues with my left elbow for about two years. Initial thoughts were “tennis elbow with involved and compensatory muscle strain”. During that time I have had three cortisones injections, the most recent in early April 2020. My Orthopedic physician told me that it is common practice to “nick” the tendon a bit to stimulate natural healing while the cortisone is being injected – NOT a pleasant feeling. At the end of May 2020 I sustained a spontaneous injury while driving which resulted in – via MRI diagnosis – a high-grade partial thickness tearing of the common extensor tendon. With subtle, diplomatic suggestion, my physician offered – as “conjecture” – the possibility that the tear was made easier to happen by the three injections of cortisone over 20 months. I had signed the standard “disclosure form” that cortisone “can” weaken or cause damage to tendons, etc. So now, I am in a light, supportive (and restrictive) brace that goes 4 inches above and 4 inches below my elbow. I have already been wearing a 3-strap brace at the wrist that prevents me from using my forearm muscles. So the strategy now is to wear these braces and do more specific Occupational Therapy for 6-8 weeks, then re-assess. If I am not where I need to be with healing, my options thereafter are Platelet Rich Plasma injection whereby they draw ~60ml of your blood, and centrifuge it in the office to draw-off the platelet-rich fraction, and then re-inject it right into the elbow to promote faster healing. The problem with that is a financial one. The FDA and insurers have not approved it for insurance or Medicare reimbursement, so it is $850 per injection, and you might need up to three over time ($2,000 with “discount!). The other option is surgery. So, my advice is “IF” your doctor says you need a cortisone injection, ask for alternatives, but if there are none, insist on only ONE injection, and insist that the doctor does NOT “nick” the tendon during the injection. I believe that “nicking” process damaged my extensor tendon, which lead to a more vulnerable state of weekend tendon and weakened strength, thus causing my 70% tear.

  2. Susannah Todd says

    I’m not sure . I was in a really bad car accident in 2005 which caused my achromiovascular wide separation 3 of my right shoulder. Never recovered because I didn’t get surgery or physical therapy. Then in 2016 I had a massive bicycle crash and hit my head. Straight to the pavement which caused whiplash and my brain to rick left to right 4 times.I don’t recall having an accident which would cause damage to m6 elbow. It simply started to hurt really bad one day and has not stopped . So my doctor sent me to get an ultrasound. And now I’m going to start seeing a specialist .Not sure if either accident is causing the pain. I know it still hurts a s it’s been 4 months

  3. Interesting though, today I learned that i have a high-grade partial-thickness tearing at the common extensor tendon origin.
    I’m 10-11 weeks out from the unexplained onset. I’m right handed Not left-side with injury. Nothing repetive. But today after further reading discovered that the-not as common- mechanism of injury was most likely explained with multiple unintentional direct strikes, yup while swinging a raquetball raquet with my right and either over swinging and missing the ball -resulting in me smacking the lateral epichondro area one to many times…
    Now I suppose I’ll try PRP injection then off to surgery.. yaay!

  4. Are you planning on having surgery on your elbow or has the physical therapy helped enough where you won’t need it? I have a partial tear of my ACL and i’m considering therapy with the hopes of preventing surgery.

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