Tendon injuries

What is a tendon injury?

There are several types of tendon injuries:

• Acute inflammatory injuries are inflammations of the tendons within their sheath. These are inflammatory tenosynovitis.
• Inflammatory injuries can become chronic, with the presence of scar tissue adhering to the tendons and restricting their mobility. After long periods of inflammation, the tendons can become stiff and develop intra-tendinous calcifications or even cartilaginous metaplasia.
• Fissure injuries appear in areas of relative weakness in the tendons, that is, where they are less well vascularized.
• Tendon dislocations correspond to a displacement of the tendons, which are no longer located where they are most effective.
• Tendon detachments are seen during violent muscle contractions affecting damaged, degenerative tendons.
• Tendon lacerations should be suspected in the presence of any wound, even if it appears shallow.

What are the causes?

Inflammatory tendon lesions are caused by excessive and unusual muscular strain. Fissure lesions appear in poorly vascularized tendon friction zones, but also in cases of tendon instability, particularly in patients with joint hyperlaxity which predisposes them to dislocations. These vascularization problems can also be observed in other conditions such as compartment syndrome, which may compromise the blood supply to musculo-tendinous tissues.

Tendon dislocations should be looked for in cases of fracture, as tendons may become trapped in some fracture sites. Tendon dislocations can occur during violent weight-bearing resumption, particularly for the peroneal tendons.

Tendon avulsions correspond to tendon tearing from the bone. This occurs in complete ruptures of the biceps tendon at the elbow, which is totally detached from its insertion at the tuberosity of the radius. This specific case is an example of an imbalance between muscle power and tendon quality.

Distal biceps tendon avulsion at the elbow predominantly affects males over the age of 40. Several predisposing factors have been identified, including active smoking, manual occupational activity, resistance training, and the use of anabolic androgenic steroids.

What treatments are possible for tendon injuries?

Therapeutic options depend on the tendon injuries and whether or not they are symptomatic.

Natural evolution

There is no possibility of spontaneous healing of tendon lesions. However, not all tendon lesions are symptomatic and therefore do not require systematic treatment.

Rehabilitation

The correction of sports technique and rehabilitation are the first step in the treatment of acute or chronic inflammatory tendon lesions. Symptomatic fissure lesions, tendon dislocations, detachments, and tendon ruptures generally require surgical treatment.

Surgical treatment

The ideal is to be able to suture the torn tendon directly in order to achieve its healing. However, the torn tendon itself may be damaged or degenerative. In this case, it may have a low healing potential despite tendon suturing.If tendon repair is impossible or unreasonable, we may resort to a tendon graft or a tenodesis, which involves suturing the damaged tendon to a neighboring tendon.

Tendon dislocations can be reduced. It is necessary to surgically reposition the dislocated tendons and correct any associated tendon dislocation factors. Tendon lacerations observed during the exploration of wounds, particularly from glass, can be repaired. Tendon detachments can be repaired in the upper limb and must be repaired in the lower limb.

Detachment of the tibialis anterior tendon in the foot is rare but classic. This muscle is the main foot lifter; its tendon must be repaired quickly. However, diagnosis is generally made late, and it may then be necessary to perform a so-called palliative tendon transfer to restore some function to the tibialis anterior and allow active dorsiflexion of the foot when walking.