Tendon Injuries: When Movement Becomes Compromised

A tendon is a fibrous structure that connects muscle to bone, allowing muscle contraction to be converted into movement. When a tendon is injured, this transmission of force is disrupted, and the movement controlled by that tendon may no longer occur.

Tendon injuries can be acute, resulting from direct trauma, or chronic, developing gradually due to repetitive overload. They can be partial, when only some of the fibers are torn, or complete, when the tendon is completely divided. They can occur within the tendon itself or at the junction between the tendon and the muscle.

Causes include direct trauma, cuts, crush injuries, falls involving twisting mechanisms, repeated excessive strain, progressive degeneration due to age or disease, and even certain medications that weaken tendon structure. The hand and wrist are particularly vulnerable because the tendons are superficial and constantly in motion.

The flexor tendons of the hand run along the palm side of the fingers and wrist, allowing you to close your hand, grip objects, and perform grasping movements. They are critical structures for hand function and are also particularly vulnerable to injury.

A flexor tendon injury may result from a deep cut to the palm, a crushing injury, or, less commonly, a spontaneous rupture caused by degeneration. When a flexor tendon is injured, the affected finger loses its ability to bend and remains extended, unable to flex.

The challenge in treating flexor tendon injuries is that these tendons run through a very narrow tunnel, the synovial sheath, where they glide with millimeter-level precision. An inadequate repair, excessive scarring, or improperly conducted rehabilitation can result in adhesions: the tendon becomes attached to the surrounding structures and loses its mobility, even when the repair itself was performed correctly.

For this reason, flexor tendon repair requires not only refined surgical technique but also a highly specific rehabilitation protocol, initiated early and carried out with precision.

The extensor tendons run along the back of the hand and wrist, allowing you to straighten your fingers and wrist. They are more superficial than the flexor tendons and are therefore more exposed to direct trauma.

An extensor tendon injury results in an inability to extend the affected finger or wrist. Unlike the flexors, the extensors have a more complex anatomy: they divide into multiple branches that interconnect, creating specific advantages as well as challenges.

Simple extensor injuries, such as a clean cut, often have a better prognosis than flexor injuries. However, complex injuries, particularly those involving multiple extensor tendons or the junction between them, require careful surgical planning.

Although it is not located in the hand, the Achilles tendon deserves mention because it is one of the most frequently injured tendons in the body. It connects the calf muscles to the heel and is essential for walking, running, and jumping.

An Achilles tendon rupture is generally caused by an explosive effort, such as jumping or sudden acceleration, often in people with pre-existing tendon degeneration. The patient experiences sharp pain, often described as feeling as though they have been kicked in the calf, and loses the ability to point the foot downward.

Treatment may be conservative, involving immobilization, or surgical, involving tendon repair. The choice depends on the patient's age, activity level, and individual profile. In both cases, rehabilitation is lengthy and requires patience.

Not every tendon injury is an acute rupture. Many tendon injuries develop gradually as a result of repetitive overload, improper movement, or aging of the tissues.

Tendinitis is inflammation of the tendon, generally accompanied by pain, swelling, and limited movement. Tendinosis refers to degeneration of the tendon, with disorganization of the fibers and loss of strength, often without significant inflammation. Both conditions can lead to rupture if left untreated.

These conditions are common in athletes, professionals who perform repetitive movements, and older adults. Initial treatment is generally conservative and may include rest, ice, compression, elevation, anti-inflammatory medications, and physical therapy. If the condition does not respond to these measures, more aggressive intervention may be necessary.

Sometimes, the problem is not the tendon itself, but the space through which it passes. The carpal tunnel is a narrow passageway in the wrist through which the flexor tendons and median nerve pass. When this space becomes narrowed due to swelling, inflammation, scar tissue, or simply a naturally tight anatomy, the tendons and nerve can become compressed.

Chronic tendon compression can lead to inflammation, pain, swelling, and eventually weakness. Treatment begins with conservative measures, but if symptoms persist, surgery may be necessary to increase the space within the tunnel.

A tendon avulsion occurs when a tendon is pulled away from the bone, usually as a result of direct trauma or a powerful traction force. The tendon may tear in the middle or be pulled away along with a fragment of bone.

A tendon avulsion is a functional emergency. The tendon needs to be repaired or reattached promptly to restore function. The longer treatment is delayed, the more difficult the repair becomes and the poorer the prognosis may be.

Seek specialized evaluation promptly if you notice sudden loss of movement in a finger or hand, an inability to extend or flex a finger despite effort, severe pain accompanied by swelling after trauma, visible deformity or an abnormal finger position, progressive weakness during a specific movement, or any deep cut that may have injured a tendon.

In the event of an acute injury with possible tendon involvement, seek medical attention the same day. The window for optimal repair is limited.

The evaluation begins with a detailed medical history: how the injury occurred, when it happened, the patient's dominant hand, occupation, and activity level. Each detail influences the decision regarding the most appropriate treatment.

The physical examination is thorough: we assess the strength of each movement, range of motion, sensation, pain, and swelling. Specific tests allow us to accurately identify which tendon has been injured.

Imaging studies, including X-rays, ultrasound, or magnetic resonance imaging (MRI), confirm the diagnosis and show the extent of the injury. In some cases, dynamic ultrasound, in which the tendon is assessed during movement, provides valuable information.

Treatment may be conservative, involving rest and rehabilitation, or surgical, involving tendon repair. When surgery is indicated, it is carefully planned, including the choice of suture technique, the optimal timing for repair, and the rehabilitation protocol that will follow.

Surgery repairs the tendon, but rehabilitation restores function. And this is one of the most critical parts of treatment.

After repair, the tendon goes through several stages of healing. During the first few weeks, it is fragile and must be protected from excessive stress. At the same time, it needs to be mobilized: controlled movement promotes proper healing and helps prevent adhesions.

The rehabilitation protocol is rigorous and should begin at the appropriate time under the guidance of therapists specialized in hand rehabilitation. The goal is to gradually restore strength, range of motion, and coordination while always respecting the tendon’s healing stages.

At Rio Hand Experts, postoperative care is close and continuous. We work in an integrated manner with specialized hand therapists to ensure that functional recovery occurs safely and as efficiently as possible.

Tendons are delicate structures that require an in-depth understanding of anatomy, biomechanics, and refined surgical technique. An inadequate repair, poorly conducted rehabilitation, or an undetected complication can result in permanent functional impairment.

Excellence in treating tendon injuries means knowing how to assess each case accurately, choose the most appropriate repair technique, perform surgery with precision, and closely monitor rehabilitation. This is what we do, case by case, for every patient who comes to us.

Rio Hands Experts

Berlink & Eiras Premier Care

Rio de Janeiro - Brasil