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Faq-Muscle tendon Injury

Question: What are muscle and tendon injuries?

Answer:Muscles and tendons are the tissues that move joints. The muscles are the “red meat” of the body. When they receive a signal from the brain via the nerves the muscles contract i.e. shorten and bunch. The pull is transmitted through the tendon to the bone on the far side of the joint so the joint moves. Muscles and tendons can tear through overloading e.g. lifting too much or can be cut or crushed from outside.

Question: What do they look like?

Answer:Muscle and tendon injuries are often obvious because of local pain and swelling. Initially the injury may be underestimated as patients’ are often reluctant to move local joints when they are sore from injury. Joint movement should return within days if the muscle/tendon is intact. If there is doubt, particularly if there has been a cut, then the area should be explored under anaesthetic, probably in an operating theatre by an experienced surgeon.

Question: How is the diagnosis made?

Answer:The Hand specialist who sees the patient will ask questions about their injury and in particular how it occurred. They will then examine the patient looking at the injured site. In particular they will look at movement of local joints. The Hand specialist will compare the passive movements, i.e. how much the joint can be move by someone else, with the active movements i.e. how much the patient can move their own joint.

Question: What treatment is needed?

Answer:If the muscle/tendon injuries are partial (incomplete) then rest and supervised movement are often sufficient for a very good recovery. The muscle/tendon needs to be protected for at least 6 weeks and as much as 12 weeks for heavy activities. If the tear or cut is complete than in most cases surgery would be recommended otherwise there will be significant weakness and possibly disability.
Surgery is performed under anaesthetic in an operating theatre. For injuries in the hand and fingers surgery can often be performed under local anaesthetic. Injuries further up the arm and in children typically require a general anaesthetic as do extensive i.e. multiple tendon injuries. Muscle repair is difficult as the tissues do not hold stitches (sutures) well. The repairs are therefore not very robust and need protection typically for 4-6 weeks initially and for 12 weeks for heavy activities. Tendon repairs are usually more robust but tendons heal more slowly and so again need protection. However, they also tend to stick down to local tissues, so they need to be moved early, starting within days of the repair. This movement needs to be carefully controlled and protected. This is performed protected by a splint and carefully supervised by the treating team, especially the Hand therapists.
Injuries to the bending tendons of the fingers are particularly prone to failure or to sticking down because the track in which they run is so narrow. The period of post-operative therapy requires particularly close supervision for the first 5 weeks and care for up to 12 weeks.

Question: Are there any risks from surgery?

Answer:All interventions in medicine have risks. In general the bigger the operation the greater the risks. With injuries the outcome is mainly due to the severity of the initial injury. For muscle/tendon repairs the risks include:
• The scar may be tender, in about 20% of patients. This usually improves with scar massage, over 3 months.
• Aching at the site may last for several months and possibly for ever.
• Grip strength can also take some months to return to normal if ever.
• Stiffness may occur in particular in the fingers.
• Numbness can occur around the scar but this rarely causes any functional problems.

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