Surgery is a treatment of last resort, but in exceptionally severe cases it may be the only way. It is fairly common for carpal tunnel syndrome, which seems to be less responsive to other treatments.
Surgical intervention may be recommended in the case of tendon tears, tendon ruptures and bone spurs. A bone spur can rub against the tendon, leading to inflammation, irritation and potentially, a tear in the tendon. A surgeon must remove the bone spur, and may also need to repair the tissue if it has been damaged. Most likely, the area will need to be immobilized post-operatively and a period of structured rehabilitation will be required to regain full flexibility, strength and range of motion.
There Are Two Main Types of Tendonitis Surgery. Tendonitis surgery can be performed by arthroscopic surgery or open surgery.
- An arthroscopic procedure is less invasive and can repair the tendon through tiny incisions.
- Conversely, open surgical procedures are much more invasive and will likely be necessary in the case of completely torn tendons.
Tendon repair of the hand is necessary when one or more tendons in your hand are divided or ruptured (split), leading to loss of normal hand movements.
If your extensor tendons are damaged, you will be unable to straighten one or more of your fingers. If your flexor tendons are damaged, you will be unable to bend one or more of your fingers.
Tendon damage can cause pain and inflammation (swelling) in your hand. Some common causes of tendon injuries are described below.
- Cuts : Cutting your hand can result in an injury to your tendons.
- Sports injuries : Tendons can be overstretched and rupture when you take part in sport. This is more common in contact sports such as football and rugby, or activities that involve a lot of gripping, such as rock climbing.
- Bites : Animal bites can cause tendon damage. However, human bites are a more common cause and most often occur when a person punches another person in the teeth, cutting their hand in the process.
- Crushing injuries : Jamming your finger in a door or having your hand crushed in a car accident can divide or rupture a tendon.
- Rheumatoid arthritis : Rheumatoid arthritis can cause your tendons to become inflamed. In the most severe cases, this can lead to tendons rupturing.
To reattach the tendon, sutures are placed in the tendon and then threaded through drill holes in the kneecap. The sutures are tied at the top of the kneecap.Your surgeon will carefully tie the sutures to get the correct tension in the tendon. This will also make sure the position of the kneecap closely matches that of your uninjured kneecap.
A recent development in patellar tendon repair is the use of suture anchors. Surgeons use anchors to sew the tendon to the bottom of the kneecap. Using these anchors means that drill holes in the kneecap are not necessary. This is a new technique, so data is still being collected on its effectiveness.
Most orthopaedic research on patellar tendon repair involves the direct suture repair with the drill holes in the kneecap.
Surgery for an acute Achilles tendon tear is seemingly straightforward. The ends of the torn tendon are surgically exposed and sutures are used to tie the ends together. The sutures used to tie together the torn tendon ends are thick and strong, and are woven into the Achilles both above and below the tear.
While the concepts of surgery are straightforward, the execution is more complex. Care must be taken to ensure the tendon is repaired with the proper tension not too tight or too loose. The skin must be taken care of, as excessive handling of the soft tissues can cause severe problems including infection and skin necrosis. Nerves are located just adjacent to the tendon, and must be protected to prevent nerve injury.
If surgery is decided upon, it is usually performed within days or weeks of the injury. The idea is to perform the repair before scar tissue has formed, which would make the repair more difficult. Some surgeons may recommend delaying surgery a few days from the initial injury to allow swelling to subside before proceeding with the repair.
Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated.
Several procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair.
However, in some patients, these procedures can help restore function of a chronically damaged Achilles.
Some common complications of tendon repair include infection, a failed repair (which can cause the tendon to snap) and the repaired tendon sticking to nearby tissue.
A post-operative infection develops in around 5% of cases of tendon repair. The risk of infection is highest if you damage your hand in an environment where there are a lot of germs, such as a farm. Crushing injuries are also more likely to cause an infection.
Symptoms that may indicate that your hand has developed an infection include:
- redness and swelling in your hand
- a feeling of tenderness or pain
- a high temperature (fever) of 38°C (100.4°F) or above
Contact your GP if you think you have developed an infection. Most infections can be successfully treated with antibiotics.
In an estimated 5% of cases of tendon repair, the repair fails. This results in the snapping of the repaired tendon.
Most tendon snaps occur soon after the operation, when the tendon is weakest. Tendon snaps often happen in people who do not follow the advice about resting the affected tendon. Accidental trips, falls or suddenly catching your splint on an object can also snap the tendon.
Sometimes, it is obvious that you have snapped the tendon because you notice a sudden snapping or ‘pinging’ sensation in your hand. However, you may not notice that the tendon has snapped until you discover that you cannot move your finger or fingers in the same way as before.
If you think that your tendon has snapped, contact your surgical team. Further surgery is usually required to repair the tendon.
Tendon adhesion is a medical term which means that the tendons have become stuck to nearby tissue and have lost some of their range of movement, specifically the ability to move around bones. This movement is known as tendon glide.
This can cause some loss of movement, which in most cases is minor.
More serious cases of tendon adhesion require surgery to free the stuck tendon.
Tendonitis treatment before surgery,
november 10th, 2013