Tendon Injury - Causes, Treatment, And Complications

Introduction:

The tendon is a fibrous connective tissue that connects the muscle to the bone. An injury to the tendon can cause damage to it, which can result in pain, swelling, and decreased range of movements. Conservative treatments such as rest, cold and hot compressions, splints, and anti-inflammatory drugs can be used. In severe cases, tendon repair is done by surgical methods.

What Is a Tendon and Tendon Sheath?

Tendon is a fibrous tissue that connects muscle to bone. The tendon helps in movement. There are many tendons, the calf muscle tendon, called the Achilles tendon, is the largest. Tendons are tight structures, stronger than muscles, and do not stretch; if injured, it takes a long time to heal. They are connective tissues, made up of collagen fibers, and have blood and nerve supply. The tendons of the wrist and foot run down in a narrow tunnel made of ligaments and bones; these tendons are protected by a covering of connective tissue called a tendon sheath, which helps the tendon to move freely.

What Are The Symptoms Of Tendon Injury?

The symptoms of tendon injury are:

• Pain.

• Tenderness.

• Swelling.

• Difficulty in moving the joint.

• Crackling or grating sensation while moving the joint.

• Stiffness near the affected area.

• Decreased range of movements.

• Weakness around the joint.

What Are the Causes of Tendon Injury?

The causes of tendon injury are:

1. Strains: It occurs when the tendon has a twist, pull, or tear. It is affected mostly in the arms and legs.

2. Tenosynovitis: This is a condition of inflammation of the tendon and the tendon sheath. It commonly occurs in the feet and hands. There are two types:

   • Trigger Finger or Thumb: This occurs when the finger or thumb gets stuck in a curved position.

   • DeQuervain’s Tenosynovitis: It affects the thumb, which results from grasping. repetitive action or inflammatory conditions like arthritis.

3. Tendonitis: It is a condition of the inflamed tendon that occurs due to overuse, repetitive movement, and aging. It often occurs in the leg, hip, knees, shoulder, elbow, and thumb. The common types are:

   • Rotator cuff tendonitis, which is the inflammation of the shoulder tendon.

   • Patellar tendonitis is the tendon inflammation that connects the shinbone (tibia) and kneecap (patella).

   • Tennis elbow is the inflammation of the tendon around the elbow and occurs when there is overuse of the forearm.

4. Biceps Tendon Injuries: Occurs in the shoulder or elbow, which are micro-tears due to injury or repetitive action.

5. Posterior Tibial Tendon Dysfunction: It occurs in the posterior part of the foot.

6. Tendinosis: It is a chronic condition where collagens accumulate in the tendon and causes tendon damage.

7. Rotator Cuff Tears: It is a condition where the shoulder tendon is completely or partially detached from the arm bone, which occurs commonly due to injury or excessive use.

How Are Injured Tendons Diagnosed?

The diagnosis of an injured tendon includes:

• A physical examination includes palpation of the tendons, evaluation of joints, and evaluation of the flexibility of the tendon.

• Diagnostic methods such as arthrocentesis (joint aspirations), ultrasound (sonography), magnetic resonance imaging (MRI), and X-rays can be done.

What Are the Treatments for Injured Tendons?

Treatments of tendon repair include:

• Resting the affected part.

• Ice or heat compression.

• Anti-inflammatory medication to relieve pain.

• Use of splints.

• Exercises or physical therapy.

• In case of severe damage and torn tendons, surgery should be performed.

What Is the Surgical Procedure for Tendon Repair?

The surgical procedure should re-establish the tendon continuity and gliding movements with the surrounding structures. factors while planning the reconstruction of joints, depending on the type of injury, degree of injury, tissue loss, degree of nerve injury, vascular supply quality, presenting contaminated wound, and the quality of the surrounding tissue. A good blood supply, stable bone fixation, functioning flexor sheath, and adequate soft tissue coverage are required for proper healing and gliding movements. Primary reconstruction should be followed by comprehensive debridement. The types of reconstruction are:

• Primary Reconstruction: It is done within two weeks of injury. A wide-exposure Bruner incision is made to explore the injury, and bone and neurovascular structures are repaired. The tendon repair is made with epitendinous peripheral suture, which gathers the tendon strand four core-strand technique is used. flexion and gliding movements should be checked intraoperatively. early active motion protocol is initiated postoperatively. Tendon grafting is used in case of extensive tendon loss.

• Delayed Reconstruction: Due to the complexity of the injury, primary repair is not possible. It has one-stage reconstruction, where the preoperative conditions have satisfying good results. Two-stage reconstruction is done where the preoperative conditions have complications like tissue scarring, decreased range of movements, nerve damage, and improper wound healing.

Other procedures include:

• Arthrodesis: It is indicated in patients who cannot undergo complex reconstruction procedures, mostly older people. It is a surgical procedure where diseased joints are fused.

• Tendon Transfer: It is done in case of a total loss of function of a single or group of tendons.

Postoperative rehabilitation after the surgical procedure includes:

Rehabilitation should include physical therapy (hourly “place and hold exercises”) and psychological, occupational, and social support. Postoperative immobilization is indicated in elderly, very young patients and patients with conditions such as rheumatoid arthritis. But controlled early postoperative motion has improved healing, and strength, and reduced adhesion rate. After six weeks, the splint is removed, and daily activity should be started. After three months, strengthening exercises should be incorporated.

What Are the Complications of Surgical Tendon Repair?

The complications of tendon repair surgery are:

• Infection in case of heavily contaminated wounds or fractures.

• Stiffness of the joint.

• Contractures are fixed tightening of the tendon due to aggressive splinting postoperatively.

• Repair ruptures.

• Lumbrical plus deformities (extension of the joints while attempting to flex in case of interphalangeal joints).

• Quadriga phenomena (reduced flexion).

• Adhesion formation results in impaired tendon gliding and decreased movements, which occur on the graft sites. in such cases, tenolysis can be performed to release adhesion.

Conclusion:

Therefore, regular exercise, which increases flexibility and strength, and warming up before exercising should be incorporated daily to prevent tendons from tearing. Medical conditions such as diabetes increased physical activity, and age can increase the risk of tendinitis.