We have all heard of someone straining their hamstring. We likely also know someone who has torn their rotator cuff. But what exactly are these injuries? And what should you know if you have been diagnosed with a similar injury? The answer can be found by beginning to understand the importance of tendons in the body.
Tendons are dense fibrous connective tissues that attach muscles to bones. They work in conjunction with muscles to move joints in the body. Tendons are strong and can withstand large forces, but are relatively inflexible. A variety of mechanisms can lead to tendon injury. Sometimes inflammation or tearing can occur simply through overuse. In other scenarios, injuries to tendons can be more acute or sudden.
Tendon injuries are classified as follows:
- Grade I - tendon fibers are stretched but not torn; mild tenderness and swelling; joint remains stable
- Grade II - tendon fibers are partially torn; mild to moderate tenderness and swelling; joint is unstable and strength is reduced
- Grade III - complete tear of tendon fibers (rupture); marked tenderness and swelling, deformity may be present; joint does not move on muscle contraction
Diagnosis of tendon injuries is made by a physician, preferably one trained in sports medicine. The diagnosis is supported by a relavent history, associated physical exam finding, and often imaging. Ultrasound is a quick, cost-effective, and dynamic method for evaluating tendons. An MRI may provide more detailed information about the injury.
Treatment of tendon injuries can be either surgical or non-surgical. If the tendon is completely torn (Grade III), surgery is generally recommended. You may be a candidate for Regenerative therapy such as Platelet Rich Plasma which is done at SSMI Ultrasound-Guided. Before proceeding with surgery, your doctor should take into consideration your overall health and function. For less severe tendon injuries, treatment is more conservative and will often include referral for physical therapy. Therapy can be approached in the following three phases:
- Phase 1 - Rest, ice, protection from further injury, anti-inflammatory medications, and therapeutic exercise to promote neuromuscular control
- Phase 2 - Continue Phase 1 treatment with advancement of therapeutic exercise to include increased range of motion and flexibility
- Phase 3 - Removal of restrictions and advancement to full athletic participation
While tendon injuries can be very painful and limiting, there are options to help you heal. If you believe you may have suffered a tendon injury, we advise you to seek evaluation by Dr. Carfagno. Call the office today to schedule an appointment.
Bryce Kirkman, MS-IV
David Carfagno, D.O., C.A.Q.S.M.
Thomopoulos S, et al. Mechanisms of tendon injury and repair. Journal of Orthopedic Research. 2015:33(6), 832-9.
Maffulli N, et al. Types and epidemiology of tendinopathy. Clinics in Sports Medicine. 2003:22(4), 675-92.
Heiderscheit BC, et al. Hamstring strain injuries: Recommendations for diagnosis, rehabilitation, and injury prevention. Journal of Orthopedic and Sports Physical Therapy.2010:40(2), 67-81.
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