Sports Medicine

Tendon Injuries

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Tendons are tough fibrous tissues that connect bones to muscles. Tendon injuries are often the result of overuse and can range in severity from tendonitis, which is the inflammation of the tendon, to tendinosis, which is tiny tearing in the tendons, to frank tears, which can be partial or full tendon tears (tendon ruptures). Typical treatment for less severe tendon injuries, such as tendonitis and tendinosis, can be remembered using the acronym “RICE” – rest, ice, compression, and elevation. Patients should rest and cease activities that involve the affected joint or extremity, apply an ice pack to the affected area for 10-20 minutes at a time with a towel in between the cold pack and skin, compress the affected area with an elastic bandage to reduce swelling, and elevate the extremity at or above the level of the heart. Immobilization of the affected joint and physical therapy are other nonsurgical treatment options depending on the situation. Platelet rich plasma injections into the injured tendons can also help with tendon healing and recovery. Surgery may be necessary in the case of tendon tears, in which the torn tendon is reattached together or back to bone through the use of sutures. The following are some of the typical tendon injuries that Dr. Dines treats.

Distal Biceps Tendon

The biceps muscle is an important muscle in the upper arm. The distal tendon of the biceps muscle transmits all of the forces of the muscle to the forearm at its insertion (“radial or bicipital tuberosity”), thereby contributing to an athlete’s ability to forcefully flex the elbow as well as rotate their forearm in turning the palm upward (“supination”).

PRP was initially though of as a last effort for conservative treatment before considering surgery. However, because PRP can potentially heal injuries as opposed to just decreasing inflammation (which is what a cortisone shot does), it is now being used earlier and more frequently to treat certain injuries. Conditions that respond well to PRP injections include Lateral epicondylitis (Tennis elbow), medial epicondylitis (golfer’s elbow), Achilles tendonitis, patellar tendonitis and elbow ulnar collateral ligament injuries. Rest and a progressive stretching and strengthening program are usually recommended after having a PRP injection.

The distal biceps tendon can tear, preventing the transmission of forces from the muscle to the forearm bones. While it can happen from repetitive injury in athletes, it more commonly results from a single traumatic event in which the flexed elbow is resisted or even traumatically extended as in Sander’s case. The event is usually accompanied by a “popping sensation” and sense of sharp tearing around the elbow crease.

Once a distal biceps tendon is ruptured, it unfortunately will not heal on its own. Rather, the tendon will continue to retract away from the bone and slide up the arm as the muscle contracts without resistance. Over time, the tendon will be come stiff and scarred as well. This loss of biceps muscle function results in a loss of elbow flexion and forearm rotation strength (specifically turning the palm “upward”) in the arm. These injuries should be addressed acutely with surgical repair.

Usually the presentation of a distal biceps tendon is not subtle. There will be the acute onset of a “tearing sensation” at the elbow, often accompanied by a “pop” when the tendon ruptures off the bone. When compared to the normal arm, the tendon can no longer be palpated at the elbow flexion crease. Frequently, there is swelling and bruising around the elbow flexion crease as well.

Typically the diagnosis can be made by taking a history from the patient and performing a physical exam. Often, an MRI will be ordered to confirm a complete tear of the tendon as well as to assess any potential retraction of the tendon. Over the past few years, surgical techniques and implants have improved, which, when combined with people trying to stay more active, has led to an increasing number of distal bicep tendon repairs being performed. In the past, 2 incisions were typically needed to repair the tendon whereas now 1 is often used. Patients are protected in a brace for the first 6 weeks after surgery after which they progressively work on strengthening exercises before returning to sports. If one opts for surgical treatment of a distal biceps tear, the best results are achieved when done within 4 weeks of the initial injury.

Achilles Tendon

The Achilles tendon connects the calf muscles to the heel bone and is one of the longer tendons in the body. Achilles tendon injuries are common amongst athletes, who participate in sports such as basketball, baseball, football, volleyball, tennis, and running. Achilles tendonitis is commonly caused by overuse. Proper stretching is important to prevent the muscles and tendons in the leg from over tightening, which can cause Achilles tendonitis.

Achilles tendon tears are more likely to occur during sudden and explosive movements. Injuries to the Achilles tendon are often accompanied by pain, swelling, tenderness, and stiffness above the heel along the back of the foot and can be diagnosed by physical examination or diagnostic imaging, such as X-ray or MRI.

In active patients who wish to continue participation in sports, surgical repair of the Achilles tendon can be performed in the case of a tear or rupture. In surgery, the torn tendon is sewn back together using sutures. The patient is placed in a splint or cast and must use crutches, a walker, or wheelchair to remain mobile. The cast is usually removed after 6 weeks and the patient is allowed to participate in physical therapy to gradually return to sports.

Quadriceps Tendon

The quadriceps tendon connects the quadriceps muscles of the front of your thigh to the kneecap (patella) in your knee. The quadriceps tendon works with the patellar tendon, which connects the kneecap and the shinbone, to straighten the knee. Injuries to the quadriceps tendon are usually a result of stress to the muscles and tendons of the knee from running, jumping, and explosive stopping and starting movements. Common quadriceps tendon injuries include tendinosis, in which microtears occur in the tendon, and quadriceps tendon tears, which can range from partial to complete tears (ruptured tendon).

Overuse is a frequent cause of quadriceps tendonitis and tendinosis. Tendon tears can result from an excessive load on the leg while the foot is planted on the ground or from weakened tendons caused by tendonitis or tendinosis. Quadriceps tendon injuries are usually accompanied by pain and swelling and can be diagnosed by physical examination or diagnostic imaging, such as X-ray or MRI.

In the case of quadriceps tendon tears, surgery is required to repair the torn tendon. In the case of surgery, the torn tendon is traditionally reattached to the top of the kneecap through drill holes in the bone. The use of suture anchors is a relatively new method of surgical treatment that allows for the tendon to be reattached to the kneecap without the use of drill holes. The best outcomes are achieved when surgery is performed early after injuring the quadriceps tendon. The knee is usually immobilized after surgery with a knee immobilizer or cast. Recovery can take up to 6 months and, with the help of physical therapy, a gradual return to sports can be expected up to 12 months after surgery.

Patellar Tendon

The patellar tendon connects the bottom of the kneecap (patella) to the top of the shinbone (tibia). The patellar tendon works with the quadriceps tendon, which connects the kneecap and the quadriceps muscles, to straighten the knee. Injury to the patellar tendon, also known as “jumper’s knee”, commonly occurs in athletes who participate in jumping sports, such as basketball, volleyball, and high and long jumping. Despite the name, jumper’s knee is common in athletes who participate in running sports as well.

Jumper’s knee is usually an overuse injury and can range from tendonitis, or inflammation in the patellar tendon, to tendinosis, or small micro-tears in the tendon, to partial and full tears (ruptured tendon). Jumper’s knee is often accompanied by pain, swelling, tenderness, and an inability to straighten the knee and can be diagnosed by physical examination and with the help of diagnostic imaging, such as X-ray or MRI.

Surgical treatment for patellar tendon tears is performed to reattach the torn tendon to the kneecap. The tendon is reattached to bone using sutures that are threaded through drill holes in the kneecap. The use of suture anchors is a relatively new method of surgical treatment that allows for the tendon to be reattached to the kneecap without the use of drill holes. The best outcomes are achieved when surgery is performed early after injury to the patellar tendon. The knee is usually immobilized after surgery with a knee immobilizer or cast. Recovery can take up to 6 months and, with the help of physical therapy, a gradual return to sports can be expected up to 12 months after surgery.