Tendon injuries and treatments

A tendon is a fibrous connective tissue that attaches muscles to bones. A tendon serves to move the bone or structure. Tendons connect the ends of muscles to bones, whereas ligaments connect bones to other bones. Tendons connect the skeletal system to the muscular system by attaching muscle to bone. When muscle contracts, the tendon acts on the bone, causing movement.

The most important tendons in the human body are the tendons of the shoulders and arms, pelvis and feet, head, neck and trunk.

Tendinitis

Tendinitis is inflammation of a tendon, the thick fibrous cords that attach muscle to bone. The condition causes pain and tenderness just outside a joint. While tendinitis can occur in any of your tendons, it’s most common around your shoulders, elbows, wrists, knees and heels. Although tendinitis can be caused by a sudden injury, the condition is much more likely to stem from the repetition of a particular movement over time. Most people develop tendinitis because their jobs or hobbies involve repetitive motions, which put stress on the tendons such as tennis, swimming, basketball, baseball and golf.

Using proper technique is especially important when performing repetitive sports movements or job-related activities. Other causes of injury include incorrect movements while walking or standing, or abnormal pressure on one of the body parts due to a congenital defect in one of the joints.

Some diseases may cause tendinitis, such as rheumatoid arthritis, osteoporosis, diabetes, and in some cases, metabolic problems, or as a side effect of taking some medications.

As people get older, their tendons become less flexible, which makes them easier to injure. While tendinitis can occur in any of your tendons, it’s most common around your shoulders, elbows, wrists, knees and heels.

Signs and symptoms of tendinitis tend to occur at the point where a tendon attaches to a bone and typically include pain often described as a dull ache, especially when moving the affected limb or joint, tenderness and mild swelling. The goals of tendinitis treatment are to relieve your pain and reduce inflammation. Often, taking care of tendinitis on your own — including rest, ice and over-the-counter pain relievers — may be all the treatment that you need.

Physical therapy is essential in tendinitis. You might benefit from a program of specific exercise designed to stretch and strengthen the affected muscle-tendon unit. For instance, eccentric strengthening — which emphasizes contraction of a muscle while it’s lengthening — has been shown to be a very effective treatment for many chronic tendon conditions, and is now considered first line treatment.

Sometimes your doctor may inject a corticosteroid medication around a tendon to relieve tendinitis. Injections of cortisone reduce inflammation and can help ease pain. Corticosteroids are not recommended for tendinitis lasting over three months, as repeated injections may weaken a tendon and increase your risk of rupturing the tendon.

Platelet-rich plasma (PRP) treatment involves taking a sample of your own blood and spinning the blood to separate out the platelets and other healing factors. The solution is then injected into the area of chronic tendon irritation. In situations where physical therapy hasn’t resolved symptoms, your doctor might suggest ultrasonic treatment. This minimally invasive procedure uses a small incision to insert a special device that removes tendon scar tissue with ultrasonic sound waves.

Also, dry needling involves making small holes in the tendon with a fine needle to stimulate factors involved in tendon healing. Depending on the severity of your tendon injury, surgical repair may be needed, especially if the tendon has torn away from the bone.

Tendon Rupture

A tendon rupture is a partial or complete tear of your tendon. Tendons are tough bands of tissue that attach your muscles to your bones. A tear may be caused by an injury or increased pressure on the tendon that occurs during sports or a fall. 

The signs and symptoms of a tendon rupture include tearing or popping sound at the time of the injury, pain or tenderness in the area of the ruptured tendon, weakness or stiffness in the injured area, swelling, bruising and trouble walking or moving the area where the tendon rupture occurred.

The Achilles tendon is a large, strong fibrous cord that connects the calf muscles in the back of the leg to the back of the heel bone. An Achilles tendon tear is most often caused by a sudden, forceful motion that stresses the calf muscle. This can happen during an intense sports activity or even when you just run or jump.

Symptoms of an Achilles tendon tear may include a sudden, sharp pain. Most people feel or hear a pop. You may have swelling and bruising. You may not be able to point your foot down or stand on your toes. Some people with partial tears may not have any symptoms. When the calf muscles flex, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running, or jumping. Despite its strength, the Achilles tendon is also vulnerable to injury, due to its limited blood supply and the high tensions placed on it.

Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people, particularly athletes, tend to choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment.

Non-surgical treatment typically involves resting the tendon by using crutches, applying ice to the area, taking over-the-counter pain relievers and keeping the ankle from moving for the first few weeks, usually with a walking boot with heel wedges or a cast, with the foot flexed down.

However, a nonsurgical approach might increase your chances of re-rupture and recovery can take longer. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair might be reinforced with other tendons.

Ruptured tendons

Ruptured tendons in the finger or shoulder is a common health problem that can occur in sports, or because of an accident or carrying heavy objects. The patient needs an operation to repair the ruptured tendon. Physical therapy and rehabilitation are needed after the operation because they are essential to help the patient regain his normal movement.

A jammed finger is a common injury that can cause pain, swelling, and difficulty moving the finger, a crackling sound at the time of the injury and bruising two days after the injury.

It is necessary to consult a doctor immediately after the injury in order to start following the appropriate treatment plan that is determined after the diagnosis. Surgery is often needed to repair the ruptured tendon.

In light of the medical breakthroughs, miniature surgical instruments are inserted to remove the damaged part of the tendon and injured surrounding tissue. The damaged ends of the tendon are sewn together. Depending on the location of the injury, it can take up to 3 months for the repaired tendon to regain its previous strength.

Physical Therapy and Rehabilitation

Physical therapy and rehabilitation is an inevitable stage during treatment as it contributes to strengthening the tendons and muscles of the foot by combining strength and stretching exercises to relieve the symptoms of tendinitis. The goal of rehabilitation is to strengthen the muscles so that the patient regains his normal movement, which requires a few months, whether after surgical or non-surgical treatment. Rehabilitation will help the patient improve muscle function, increase endurance and maintain range of motion.

Physical therapy plays a major role in treating tendinitis through therapeutic exercises, whether carried out by the physical therapist or performed by the patient at home under the supervision of the specialist.

Cold and heat therapy works by improving circulation and blood flow to a particular area due to increased temperature. Increasing the temperature of the afflicted area even slightly can soothe discomfort and increase muscle flexibility. It can relax and soothe muscles and heal damaged tissue.  In addition to exercises, thermal and infrared devices in addition to electrical muscle stimulators (EMS devices), as well as ultrasound and laser devices can be used.

Physical therapy requires several sessions, and the number of sessions varies according to the condition and severity of the pain, but it is not less than 6 sessions and often does not exceed 24 sessions.