There are two main types of tendon:
- Flexor tendons, which work by tightening to pull on the bones. An example of using a flexor tendon is when someone makes a fist.
- Extensor tendons, which work by stretching when a part of the body needs to move outward, such as when standing on the toes or straightening the fingers.
Reasons for tendon repair
A person may need surgery if they experience a deep cut or tear to one or more of their tendons.
People who may require tendon repair surgery include those with:
- a deep cut that severs a tendon
- an injury from contact sports
- a tear or injury due to rheumatoid arthritis
If a person visits the doctor with a tendon injury, a doctor will carry out an initial physical examination of the injured area.
They will check for:
- foreign objects, if the injury is due to a cut
- blood loss
- signs of infection
- other injuries, such as fractures, dislocations, nerve injuries, or injuries to the blood vessels
The doctor will also compare the injured part of the body to the non-injured side, checking for a difference in the range of motion.
They will also likely ask the person to try to move the damaged part of their body in different directions to get a more accurate diagnosis of the injury.
Imaging tests, such as ultrasounds and MRIs, can also help diagnose the precise cause and location of the tendon injury.
Tendon injuries often require surgical treatment. The aims of tendon repair surgery are:
- to bring back normal range of motion and function to an injured tendon
- to provide pain relief
A doctor will provide anesthetic before surgery.
Before surgery for tendon repair, doctors will explain the procedure and provide anesthesia, which will prevent the person from feeling any pain.
There are three possible types of anesthetic a doctor may use:
- General anesthetic: The person will be unconscious and unable to feel any pain.
- Regional anesthetic: This anesthetic will numb a large area of the body around the affected area. The person will be awake during surgery but will not feel pain.
- Local anesthetic: This anesthetic numbs only the area that needs surgery. The person will be awake during the procedure but will not feel any pain.
The type of anesthetic a person receives will depend on:
- their medical history
- where the tendon is in the body
- anything else the surgeon needs to do in addition to the tendon repair
The surgeon may want to see the person try to move their tendon as soon as possible after the surgery, or during, if they are awake, to ensure the procedure was successful.
The following steps occur during most tendon repair operations:
- The surgeon will make at least one cut through the skin in the area above the injured tendon so they can see it and look for injuries.
- They will remove any damaged tendon tissue.
- They will carefully sew any torn ends of the tendon back together.
- Once this is complete, the surgeon will sew the cut skin back together with medical stitches.
- A doctor or nurse will cover the wound and stitches with fresh medical dressings.
- A splint or similar dressing can reduce tension while the tendon heals. If there is too much tension on the tendon, the repair will fail and re-tear.
The tendon may be too short for the surgeon to sew it back together as it is. If this is the case, the surgeon will graft an extra piece of tendon between the ends to make them meet.
The surgeon will usually take the healthy tendon tissue for the graft from another part of the person's body.
A person may require a tendon transfer. A tendon transfer involves a surgeon removing a tendon that is close to the severed tendon and sewing it into the place of the broken tendon to restore function.
Surgeons usually take tendons from areas where the body has two tendons but can manage with just one.
Aftercare and recovery
It is important to keep the affected area elevated for a few days after surgery.
There are three stages to the timeline of tendon healing after surgery.
- Inflammation: For the first 3–5 days, the area may feel swollen while the body works to heal itself.
- Early repair: During the next 3–6 weeks, the range of motion will start to return, but the area may feel slightly stiff.
- Later repair: After 10–12 weeks, the swelling will have gone down, and the tendon will be easier to move.
In most cases, a person can go home shortly after having tendon repair surgery. The medical team will recommend some physical therapy or occupational therapy exercises to help bring back the range of motion slowly and safely. A person should not begin doing the exercises until a doctor says it is safe to do so.
It is essential to keep the area elevated to prevent pain and swelling for the first few days.
Common risks of tendon repair include:
- joint stiffness and loss of motion
- scar tissue
- the tendon tearing again
Additional medical conditions can affect how successful tendon repair surgery is. These include:
- circulation problems
- heart conditions
- nerve conditions
- drug and alcohol addiction
A doctor will ask a person about their full medical history before the surgery and discuss the possibility of any risks and complications.
Tendon injuries are relatively common and often require surgery to repair them. Tendon repair surgeries are usually straightforward but come with some minor risks.
After the surgery, a person should slowly regain their range of motion. In some cases, however, the tendon can tear again.