Tendon Injuries

Hamstring Tendinopathy

The hamstrings are a group of 3 muscles that run down the back of the thigh. They are attached to bone by tendons at the base of the buttocks and just below the knee. The hamstring aids in flexing the knee and extending the hip, and are most commonly used in sports activities that involve running, jumping and climbing. Sudden rapid movement during sports activities such as football and track can pull on the tissues of the hamstring, causing damage to the hamstring tendons and leading to hamstring tendinopathy.

Repeated stress from long distance running can damage the hamstring tendons just under the buttocks at the pelvic bone where most hamstrings originate. Hamstring injuries are classified according to severity as minor strain (Grade I), partial rupture (Grade II) and complete rupture (Grade III). Tendon injury may be associated with inflammation (tendinitis) or degeneration (tendinosis).

Hamstring tendinopathy is usually associated with intense pain. Sometimes a pop may be felt or heard. Swelling and bruising may be present with more severe hamstring injuries.

When you present with hamstring tendinopathy, your doctor will review your symptoms and activities related to the injury. A physical examination is performed to evaluate tenderness and imaging studies such as an MRI scan, CT scan or ultrasound may be ordered to clearly view the muscles and tendons.

Hamstring tendinopathy is initially treated by resting the area, ice application, compression and elevation (RICE) to reduce pain and swelling. Anti-inflammatory medications may be prescribed. A splint or brace may be worn to take pressure off the area. Surgery is sometimes necessary to repair severely torn tendons. The goal of treatment is to restore function and prevent scarring. Scar formation and muscle atrophy may occur with prolonged inactivity which is why your doctor will encourage stretching exercises as soon as the pain is under control. Strengthening exercises are then gradually introduced to slowly return you to your regular activity. This may take several months. Inadequate treatment and early return to sports can lead to re-injury.

Adductor Tendinopathy

The adductors are a group of muscles on the inside of your thigh that help bring your legs together. Repeated or forceful movements, or sudden change in direction during certain sports activities such as tennis, football and hockey, can sometimes strain the adductors, causing injury or degeneration of the tendons that attach the muscles to bone. This is referred to as adductor tendinopathy.

Adductor tendinopathy is commonly caused by a tendon being forcibly stretched while it is being flexed, such as during a football tackle, or during side-to-side motion. Weak and poorly stretched adductor muscles are more at risk of developing tendinopathy.

Symptoms usually include groin pain and stiffness at the beginning of an activity or in the morning. Initial pain is intense and soon followed by a dull ache. You may also have difficulty running, flexing your hip, or bringing your legs together against resistance. A warmup before activity can reduce symptoms, but they usually return later. Additional symptoms include swelling, tenderness and bruising at the inner thigh.

Your doctor will review your symptoms, perform a physical examination as well as order clinical tests to evaluate the adductor muscles. Imaging studies such as X-rays, ultra sonogram, CT scan or MRI scan may be ordered to detect tears in the tendons or rule out other conditions.

If not treated promptly and adequately, adductor tendinopathy may become chronic. Your doctor will advise protection, rest, ice application, compression and elevation (PRICE) of the area. You will be advised to avoid activities that aggravate the symptoms and walking aids may be recommended to take pressure off the area while healing. Surgery may be recommended to treat tendon tears, or severe and persistent tendinopathy. Once healing has occurred, muscle stretching and strengthening exercises are gradually introduced. Sports-specific rehabilitation may also be offered.

Proximal Biceps Tendon Injuries

The biceps muscle, located in the front of the upper arm allows you to bend the elbow and rotate the arm. Biceps tendons attach the biceps muscle to the bones in the shoulder and in the elbow. Biceps tendon rupture at the shoulder joint is referred to as proximal biceps tendon rupture and rupture at elbow joint is known as distal biceps rupture.

Biceps tear or rupture can be complete or partial. Partial biceps tendon tears will not completely break the tendon. Complete tendon tears will break the tendon into two parts.

Proximal biceps tendon rupture: Two tendons that attach the biceps muscle to the bones in the shoulder, the long head tendon that attaches the muscle to the top of the shoulder’s socket (glenoid) and the short head that attaches it to the shoulder blade. Tears are more likely to occur in the long head of the biceps tendon. Tears of the short head of the biceps are very rare. But even in case of a complete tear of the long head, the short head of the biceps may allow you to continue using your biceps muscle.

Biceps tendon tear can be caused by injury such as falling down with your arm outstretched or during the act of lifting heavy objects. In case of overuse, a tendon may fray and eventually tear. Other shoulder problems such as tendonitis, shoulder impingement, and rotator cuff injuries are more likely to weaken or tear the biceps tendon. Additional risk factors such as advancing age, heavy overhead activities, repetitive overhead sports, smoking, and use of corticosteroids can also result in a tendon tear.

The most common symptom is a sudden, severe pain in the upper arm or at the elbow, depending on where the tendon is injured. At times you may hear a "pop". Other symptoms include swelling, visible bruising, weakness in the shoulder or elbow, and trouble turning your arm palm or palm down.  A bulge referred to as a "Popeye Muscle," may also appear in your arm, because the tendon is no longer holding the muscle in place properly.

Biceps tendon tear is usually diagnosed based on your symptoms, medical history, and physical examination. During the physical examination, your doctor will look for a gap in the front of the elbow. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing shoulder and elbow pain. Using an MRI scan your doctor can know whether tear is partial or complete.

Conservative treatment for a proximal biceps tendon tear includes ice application, limiting activity, non-steroidal anti-inflammatory medications to reduce the pain and keep down the swelling. To restore the mobility and   strengthen of the surrounding muscles, your doctor may prescribe certain flexibility and strengthening exercises. Surgery to reattach the torn tendon back to the bone is rarely needed. However, for patients with partial tears who continue to experience symptoms after non-surgical treatments or who want all of their arm strength back, such as athletes or manual laborers, surgery may be the best option. Complications are rare and a re-tearing of the repaired tendon is rare. Following surgical repair, you will need to do flexibility and strengthening exercises to improve the range of motion in your shoulder.