Tendon injuries are…
tendon diseases also known as tendinopathy. The clinical presentation of this condition involves tenderness when palpated, pain and swelling around the tendon.
A tendon is the term used to refer to the tough fibers that connect bones to muscles. With that said, most tendon injuries will occur near the shoulder, knee, ankle and elbow.
Tendon injuries are perceived to happen in a sudden manner but the truth is that they are as a result of continual overload of the tendons.
Medical practitioners may use the term tendinitis or tendonitis which are terms describing the inflammation of the tendons.
In most cases, the inflammation will be part of a tendon recovery or healing process and though it might result in pain, it is a good healing process.
The main problem with tendons arises when the healing rate is lower than the rate of injury. This leads to tendon dysrepair which is the when the tendinopathies will deteriorate into cell death or degenerative phase quickly.
This is accompanied by tendon collagen degeneration as a result of repetitive overloading. In this case, the tendinopathies will not have a positive response to anti-inflammatory medication and will only be best treated using functional rehabilitation.
The best management and treatment results are achieved only when there is early diagnosis and intervention.
Symptoms
Tendinopathy or tendon injuries will normally cause stiffness, loss of strength, and pain in the area affected. The following are some of the other symptoms experienced by an individual suffering from tendon injuries:
> Pain that gets worse with the use of the affected tendon.
> Stiffness that worsens during the night and sometimes when waking up in the morning.
> Crunchy sound noticed during the use of the tendon.
> In case there is inflammation, the affected area might swell, become tender, warm and turn red.
Causes
Most cases of tendon injuries result from general gradual wear and tear of the tendons as a result of the aging process or overuse.
Anyone can have a tendon injury but people who repeat a motion multiple times in their job, sports or daily life activities are more likely to develop an injury.
The tendons are designed to withstand heavy loads and multiple movements but when the movements and the load are too much to handle for the tendon, they become stressed and this is what leads to injury.
With the stress, tendons will develop micro tears which allow inflammatory chemicals and swells. These can heal fast when the condition is properly managed.
When the load is continual, the lesions happening in the tendons will surpass the healing rate or the rate of repair and the damage will progressively worsen causing dysfunction and pain.
Researchers have an opinion that the microtrauma associated with the compressive and tensile forces involved in sports or different activities can lead to tendinopathy.
For example, when the jumping movement delivers forces that are 8 times an individual’s bodyweight to the tendons around the patellar, the cumulative microtrauma will exceed the healing process and this will lead to tendon injury.
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Risk Factors
There is growing evidence that there is more than just the overload and the use that leads to tendon injuries. Men with high body fat, post-menopausal women and diabetic persons have been found to be predisposed to tendinopathies.
For this reason, these individuals are encouraged to be careful when training or when handling different activities that involve forces to the tendons.
Phases of Tendon Injuries
The inability of the tendons to adapt to the overload quickly will cause the 4-phase progression of tension injury.
The first phase is always normal and the tissues can adapt and heal, but as the phases progress there will be tendon cell death leading to rupture.
First Phase
> Reactive Tendinopathy: This is stage is characterized by tissue adaptation of the load with excellent prognosis and normal recovery. At this stage, the tendon cells can still heal the damages in a normal process.
Second Phase
- > Tendon Dysrepair: This is the stage where the injury rate surpasses the repair rate. The prognosis will be good and the tissues will attempt to heal normally. It is during this stage that the patient should avoid deterioration that might lead to permanent cell death.
Third Phase
> Degenerative Tendinopathy: This is where cell death occurs and the prognosis is poor as cells are giving up on the repair process.
Fourth Phase
- > Tendon Rupture or Tear: At this stage patients will experience catastrophic tissue breakdown, there will be loss of function with poor prognosis and surgery is the most likely option.
Diagnosis
The diagnosis of tendon injuries involves questions about health history, symptoms and the exercise regimen followed by the patient. A physical examination will be done to confirm the diagnosis.
In cases where the symptoms are severe and do not improve even with early treatment, the doctor will recommend an MRI or an ultra sound scan identify any other cause of the injury that is not related to the normal or common causes.
Treatment
In most cases tendon treatment can start at home through simple steps such as resting the painful area and avoiding the activities that make the pain worse. You can apply cold packs or ice 20 minutes at a time and keep using this method as long as it helps. Gentle range motion exercises and stretching will help a great deal in preventing stiffness. You can have your biomechanics assessed by sports physiotherapist and undertake eccentric strength programs.
In hospital steroid injections will be helpful on a short term basis (about 4 weeks). Their long term benefits are not known and the effectiveness evidence is still controversial. Other treatments may involve electrotherapy, sclerosing injections, glyceryl trinitrate patches, extracorporeal shockwave therapy, ultrasound therapy, NSAIDs, LIPUS, blood injections among many others. Different studies involving rat models of fatigue-damaged tendons indicate that the delay of exercise until the first inflammatory repair stage will assist in a faster recovery process.
Tendon related injuries are common in sports and training but can also be associated with daily life activities. If you notice some pain or stiffness in your joints, you should see a healthcare professional for a clear diagnosis that will result in proper treatment.
