Tendon Injuries and Rehabilitation
Tendon is a structure that connects a muscle to a bone. There is an origin where the muscle arises and an insertion where it attaches to. When it contracts, it decreases in length, exerts traction force on a tendon and transfers the force to move a bony structure and leads to motion.
Tendon injuries can occur in a mild form, for example, after overuse, e.g. De-Quervain disease that affects wrist. It is a tendinitis which presents with pain and swelling near the base of the thumb. Treatment is by rest, activity modification and splinting. Local corticosteroid injection and occasional surgical release may be needed for relief .
Traumatic tendon injuries usually occur with a cut, or crush injuries. It may also be affected in burn, infection and in some inflammatory and degenerative conditions. Both front and back of hand and wrist are common sites of such injuries. Other sites include shoulder, ankle, foot etc.
Diagnosis of tendon injuries relies on clinical examinations and sometimes surgery. Clinical examination may reveal loss of function or weakness of some specific joint motion . Localised pain and deficiency in tendon may be found.. However, clinical examination alone may miss partially cut tendons. Sometimes a preoperative ultrasound scan or MRI scan may help to clarify ambiguity. Surgical examination and repair may be necessary for doubtful presentations.
In general tendon injury is treated with direct repair as far as possible. There are different techniques to repair a tendon securely. The tendon injury in hand region may not require suturing if the laceration is less than 25%. Suturing is required for those bigger than 50% cut in cross-section.
The risk of tendon rupture is highest in first 3 weeks. After repair, early-protected range of motion is advocated in general for hand injuries. This is to avoid adhesions and promote tendon gliding excursion and repair strength. Scar adhesion and paucity of joint movement after repair will lead to stiffness.
Doctors and therapists may follow specific protocols for certain injuries. They may use static or dynamic splints for protection. The protocols for children ‘s hand injuries can be variable.
A repaired tendon usually achieves maximum strength at 6 months.
Apart from tendon injuries, doctors need to pay attention to any other associated structural damage such as nerve and vessel injury, fractures. All these associated injuries may affect the rehabilitation of tendon injuries.
Apart from hand and wrist injuries, Achilles tendon in the heel is another common tendon injury. Treatment of ruptured Achilles tendon remains controversial; however recurrent rupture can be reduced with primary repair, though surgical complications like wound problems may be higher
Dr. CHEUNG, Ho-man