Disease Description (Causes and Symptoms)
Definition: Tendon injury refers to a condition in which a partial tear or complete transection occurs in a tendon that connects muscle to bone. Tendons are distinct from ligaments.
Causes and pathophysiology:
- Transection caused by direct cutting (knives, glass, etc.)
- Rupture caused by sudden, excessive muscle contraction (e.g., Achilles tendon rupture)
- Weakening and rupture due to chronic inflammation (rheumatoid disease) or degenerative changes
- Degenerative injury caused by trauma (contusion, compression) and repeated friction
Main symptoms: - Fingers: inability to bend the affected joint when the flexor tendon (palmar side) is injured, and inability to extend it when the extensor tendon (dorsal side) is injured
- Foot/Achilles tendon: sudden “pop” sound or sensation of impact, heel pain, and inability to stand on tiptoe (inability to plantarflex)
- Local pain, tenderness, swelling, and a depression or palpable defect at the rupture site
Diagnostic aids: clinical examination (inspection and palpation), X-ray (to check for accompanying fractures), ultrasound (real-time assessment of the tendon), MRI (detailed evaluation)
Treatment Methods
Conservative treatment:
- For partial tears or inactive patients, immobilization with a brace, cast, or functional brace (especially for the Achilles tendon: functional immobilization or cast immobilization for 6–8 weeks)
- Pain control: NSAIDs, ice application, and rest
- Rehabilitation: gradual range-of-motion exercises and muscle strengthening (particularly gradually increasing load to restore tendon health and eccentric exercises)
- For open wounds at risk of infection, immediate cleansing and drainage, appropriate antibiotics, and tetanus prevention
Surgical treatment:
- Early repair and reconstruction are recommended for open transections, complete transections, patients with high functional demands (active or young patients), and cases with accompanying fractures or neurovascular injuries
- After repair of a finger flexor tendon (volar side), early limited active and passive motion (specialized rehabilitation protocol) is recommended — prevention of adhesions is important
- Because extensor tendons are thin and have weaker suture strength, the period during which active motion is prohibited after repair is longer
- Achilles tendon rupture: depending on the patient’s condition and activity level, surgical repair (particularly for active patients) or nonsurgical functional conservative treatment (with periodic follow-up examinations) may be selected
- Various methods are used, including suture techniques and augmentation procedures, as well as minimally invasive (percutaneous) surgery
Additional treatments and adjunctive methods:
- Physical therapy (ultrasound, electrotherapy, stretching, and muscle strengthening), shock wave therapy, and adjunctive treatments such as PRP (evidence varies)
- Extensive irrigation, disinfection, and antibiotics for infected or contaminated wounds
Precautions (including self-care): - In the early period after surgery, strictly follow the medical team’s instructions regarding immobilization and exercise restrictions
- Smoking, diabetes, and other factors can delay healing and therefore require management
- Local steroid injections may provide short-term pain relief, but should be used cautiously because of the risk of tendon weakening and rupture
Complications: - Re-rupture, adhesions (particularly of the hand flexor tendons), infection, nerve or vascular injury, joint stiffness, and chronic pain or weakness
Checklist Before an Outpatient Visit (Including Suggested Items to Bring and Questions)
Recommended items to bring:
- A list of currently taken medications (including anticoagulants and steroids)
- History of previous surgery or trauma and related test results (recent X-ray/MRI/ultrasound images or reports)
- When and how the symptoms began (when and during what activity they occurred), changes in symptoms (worsening/improvement), and pain severity (during exercise/at rest)
- Photos of the wound (in the case of an open wound) and limitations in daily life (walking, work, and exercise ability)
- Allergies and tetanus vaccination status
Key information to tell the doctor during the visit:
- Time of symptom onset, factors that worsen or relieve symptoms, previous treatments (cast, physical therapy, injections, etc.), and response
- Exercise and occupational demands (frequency of hand use at work and activity level)
Examples of General Questions to Ask the Doctor
- Is surgery absolutely necessary for this injury? What treatment options are available?
- What is the expected recovery period and degree of functional recovery?
- What are the risks of complications and re-rupture during surgery?
- What will the rehabilitation (physical therapy) plan involve, and when and how much can I exercise?
- Do my current medications (such as anticoagulants and anti-inflammatory drugs) affect treatment?
Examples of Condition-Specific Questions
- For patients with finger flexor tendon injuries: “Can I fully recover the flexion function of this finger? What type of rehabilitation can reduce adhesions?”
- For patients with Achilles tendon rupture: “Which is recommended, surgical repair or conservative functional immobilization, and what are the recurrence rates and recovery periods for each?”
(Note: Decisions regarding diagnosis and treatment are made by the treating doctor after considering the individual patient’s condition, type of injury, accompanying injuries, age, activity level, and other factors.)