Tendon injuries: what they are and why they occur

By Cristiano Antonino On May 26, 2023

Tendon injuries are events that affect tendons. Specifically, this term refers to conditions in which the tendons are overloaded and one or more small fibre ruptures occur

This term can also be replaced with the term ‘tendinopathies’

The causes of tendon injuries can be many and vary depending on various factors, such as the presence of previous pathologies, e.g. diabetes.

Certainly, in many of the cases in which a tendon injury can occur, the causes are to be found in an overload of this part of the body, which can be either functional or resulting from pre-existing conditions.

The symptoms of tendon injuries can be very complex and make everyday activities such as walking (in the case of tendons in the foot) difficult.

These symptoms may include, for example, swelling, pain, stiffness, heat and soreness.

Risk factors for tendon injuries can be different, e.g. people who play sports are more prone to trauma.

In contact sports, in particular, it is common to face such situations, especially at competitive levels or after performing an exercise incorrectly.

Traumas such as using work tools and traffic accidents also increase the likelihood of a tendon injury.

As for treatments for tendon injuries, these can consist of a very long course of treatment, characterised by medication and physiotherapy.

The time taken to treat these injuries in different individuals varies depending on the type of tendinopathy they are facing or its stage of severity.

In order to undertake the appropriate course of treatment, it is essential to make an early diagnosis.

In this way, it is possible to significantly anticipate any complications, and then initiate the appropriate therapy.

Tendon function

Tendon injuries affect the tendons, a crucial part of the body for binding muscles to insertion structures and bones.

Tendons are composed of strong substances such as collagen and elastin.

The latter specifically deals with making the tendon more elastic.

The purpose of tendons is to transmit the force of the muscles to the bones or structures to which they are connected.

In order to fulfil this function, tendons are very strong but also elastic structures because they must also be able to withstand various stresses.

Thanks also to cell renewal, tendons can be loaded, as they can adapt to the body’s characteristics and stimuli.

In fact, they are able to strengthen or weaken.

Despite this ability to change, the process can be very slow and trauma and tendon injuries can be frequent.

Classification of tendon injuries

The classification of tendon injuries is an important yardstick for identifying the type of trauma that has affected the tendon.

Using various factors, such as causes, affected areas and type of inflammation, it is possible to classify different tendon injuries and identify the most suitable course of treatment.

Classifying tendon injuries, however, is not easy

Today, there are several classifications, often named after their founders.

Of these, the most widespread is certainly the Perugia classification method, which is divided into:

tenosynovitis and bursitis, i.e. acute and chronic inflammations specifically affecting the synovial sheath and bursae;
insertional tendinopathies, which are tendon-periosteal microfractures that do not lead to any vascular reaction;
peritendinitis, which are inflammations affecting the sheath with intact tendon;
peritendinitis with tendinous imprint are lesions that inflame the sheath with constant fibrous degeneration;
tendinosis indicates the case where the tendon is dislocated, making it also stiff and inelastic, also leading to an increased risk of tearing.

The pain perceived by the subject can also be a measurement parameter for the classification of tendon injuries.

For example, injuries are divided into four stages:

I, is the stage during which the patient experiences pain only after training or after playing sports, it is the least severe and easiest to treat;
II, the patient perceives a fixed pain that leads them to reduce their activity, but not to stop it decisively;
III, in this case the patient perceives an intense pain that prevents him/her from continuing training or the activity carried out;
IV, which causes the tendon to rupture and is a very intense pain.

Sports tendon injuries

Among tendon injuries from sport, i.e. those caused by trauma incurred during sporting activity or as a result of repeated movements on a particular area of the body, several types can be identified.

These include:

the Achilles tendon, which is very common among athletes, especially professionals. In this case, the inflammation affects the calcaneal tendon, which acts as a connection between the calf muscle on the back to the heel. This disease can lead to pain, swelling and inflammation;
the supraspinatus tendon, on the other hand, is a pathology that affects the shoulder, specifically the stretch of the brachial pelvis with the rotator cuff muscles, and can also lead to severe pain during movement and swelling;
the patellar tendon is the tendon that connects the patella to the tibia, thus affecting the knee. Inflammation of this tendon also makes walking or running difficult. Among the most common causes are injuries from trauma or overloading. This inflammation also affects athletes, e.g. professional volleyball and basketball players;
the epicondyle tendon affects the elbow. This inflammation is also known as ‘tennis elbow’, an injury that affects the outer part of the elbow and precisely affects professional tennis players, who strain this part of the arm through the same repeated movement.
peroneal tendons, i.e. the tendons of the peroneal muscles; the peroneal muscles are located on the lateral side of the leg and their tendons insert laterally into the foot. Among the most common causes are intense and repeated sports activities, e.g. running and football.

Symptoms

The symptoms of tendon injuries are common among the different types of tendon inflammation.

Usually the first symptoms occur in the local area, i.e. in the area where the tendon is inflamed or receives the injury.

Among the most common symptoms are:

general pain felt during contraction of the muscle
soreness
swelling
warmth around the area of inflammation
sense of stiffness
limitation of movement
swelling
suppuration in severe cases

These symptoms can occur more or less severely, depending on several factors such as the stage of the inflammation and its cause.

Often swelling and pain can become debilitating, making it even more difficult to perform everyday actions, not just physical and sporting activities.

Causes

As mentioned above, the causes of tendon injuries can be various, but the main one is trauma.

Due to minor trauma or overloading, tendons can become inflamed.

For this reason, professional athletes are more prone to various inflammations and forms of tendonitis.

An acute event can thus lead to a change in the integrity of the tendon.

Sport, however, is not the only cause of tendon injuries.

Functional overload, caused by the same repeated movement or the use of specific tools, can also lead to tendon inflammation.

Likewise, certain systemic diseases can impair the normal architecture and composition of the tendon.

One example may be diabetes.

In addition, there can be various risk factors that cause tendon injuries and can therefore lead to tendon inflammation, especially during sporting activity.

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These factors can include, for example, the use of the wrong tools, e.g. the wrong shoes that are unable to support the Achilles tendon.

In addition, the wrong training session can also be decisive, as can the imperfect way in which the athlete performs.

Finally, the characteristics of the terrain can also be decisive, e.g. for runners, or individual predisposition can intervene.

Treatments

In order to identify the most suitable course of treatment, it is essential to make a complete and careful diagnosis of tendon injuries.

First of all, it is important to be examined by your general practitioner, so that an initial anamnesis of your condition can be taken.

By asking a few simple questions about lifestyle, previous illnesses and perceived symptoms, the doctor will be able to draw up an initial hypothesis as to their cause and, if necessary, suggest an in-depth test.

Thanks to examinations and tests such as ultrasound scans and X-rays, it is possible to detect tendon injuries and possible bone problems.

After the relevant in-depth examinations, the most suitable tendon injury remedies can be worked out for the patient.

These treatments certainly aim to restore the functionality of the tendon, thus recovering its ability to connect muscles and bones.

In acute injuries, rest, cryotherapy and anti-inflammatory therapy are recommended in the first instance.

In more complex cases, e.g. when the tendon is severed, surgery may be necessary.

Usually, surgery for tendon injuries is performed with anaesthesia, particularly in the upper limb.

This makes it possible to explore the severity of the injury and fix the tendon to the bone.

Certainly, following the operation, a course of physiotherapy is necessary, which through specific exercises and the use of dynamic braces aims to speed up convalescence and restore the tendon’s functionality.

Healing times can also be very long, which is why it is crucial to diagnose a tendon injury in good time and thus to identify the severity of the inflammation, as well as to follow the course of treatment.

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