Tendon is a part of the non-contractile connective tissue of skeletal muscles. Using one or more tendons, muscles connect to the bone skeleton or cartilage. They transmit movement caused by muscle contraction to the bone or, conversely, to gravity acting on the axial skeleton, on the muscles.
Tendons bind muscles with bones. They are in the form of jumpers, dividing the muscle into several sections. And also short, long, wide, narrow. There may be stringed, rounded, ribbon-like and laminar tendons. The double-peritoneal muscles have intermediate tendons. They pass along the lateral surface of the body muscles and penetrate into its thickness.
Like a muscle, tendons are made up of parallel tufts. The bundles of the first order are surrounded by layers of loose connective tissue and make up the bundle of the second order. A group of second-order beams forms a third-order beam. Tendons consist of dense fibrous connective tissue, they have more fibrous elements than cellular ones.
Due to this, their distinguishing feature is high strength and low stretchability. The tendon portion of the muscles grows from 15 to 25 years faster than the abdomen of the muscles. Up to 15 years, tendons are poorly developed, their growth has one intensity with muscle growth. In the body of older people there are changes in the tissues, the elasticity of the tendons is disturbed, which often leads to injury.
Protection of tendons from rupture during sudden movements and overvoltages is the longitudinal elasticity of the tendon tissue. Therefore, to prevent tendon injuries, they need to be activated, developed and strengthened, regular exercise and certain specific exercises will restore their elasticity and strength.
There is a great dictum in which great wisdom is concluded: "Whoever teaches tendons in his youth, will receive vigor in his old age." If physical effort is needed for training the muscles, then the tendons are trained by static tension. With physical exertion, the tendons and fascia are enriched with oxygen and become elastic, acquire endurance and strength.
The tendons should be elastic, the loss of this property leads to the displacement of internal organs, changes in natural forms, the formation of nodes and seals. The strength of the tendons was known to the bogatyr Alexander Zass, who created his own method of training.
Commander Grigory Ivanovich Kotovsky, sitting in captivity, practiced static exercises and was famous for unprecedented strength and endurance.
To identify the pathology of tendons use methods - palpation, thermography, ultrasonography, biopsy.
With the defeat of the tendons inside the joint, the use of arthroscopy is effective. Anomalies of tendon development are a consequence of malformations of the musculoskeletal system, an atypical course, or an unusual attachment.
There are several types of inflammatory diseases of the tendons, accompanied by a violation of the musculoskeletal system.
1. Tendonitis - an inflammatory process, occurs quite often. The reasons for its occurrence are always the same, and therefore, to diagnose this pathology is quite simple. Tendonitis occurs from long-term chronic overstrain, in which degenerative changes and tears of tendons develop. This type of inflammation reduces the strength of the tendon and increases the risk of it breaking.
Tendonitis may have an infectious nature of the course. Athletes mainly suffer from the dystrophic type, due to the great physical exertion on the muscles, ligaments and tendons. Various rheumatic diseases of the joints also contribute to the development of such inflammation.
2. Paratenonitis - aseptic inflammation of the near-tissue-burning tissue. It occurs when re-injury in the area of the joint. In this case, in the connective tissue, between the fascia and the tendon, after point hemorrhages and the appearance of puffiness, there are deposits of fibrous tissue. Knotty seals lead to painful sensations, movements are limited, activity is lost.
The disease damages the Achilles tendon, the extensors of the forearm, the lower third of the leg. Paratenonitis can have acute and chronic course. The treatment of inflammation of the tendon is the immobilization of the hand or foot. Also effective are traditional physiotherapeutic procedures.
Treatment of acute inflammation of the tendon (tendinitis) involves antibacterial and restorative methods. In the case of aseptic tendinitis, nonsteroidal anti-inflammatory drugs are used.
Local treatment is to fix the sore limb. After the acute manifestations of the disease pass, you can prescribe a physiotherapeutic procedure. Warming up must be performed after the acute manifestations of the disease have passed.
This complex of procedures includes UHF, microwave therapy, ultrasound, ultraviolet rays. Useful therapeutic exercise. Soft heat and magnetic fields, improving blood circulation, relieve inflammation, swelling of tissues, and damaged parts of tendons are restored.
Stretching - the most frequent type of injury, usually occurs in the ankle and knee joint from sudden movement exceeding their amplitude. Tendons connect muscles with bones, and ligaments connect bones. These two definitions are often confused. Sprain actually always represents a microscopic rupture with a small stretch, with a moderate degree of injury, a rupture of individual collagen fibers may occur, if the injury is severe, the whole bundle is torn.
Having a high ability to regenerate, ligaments at any degree of injury recover. The most powerful muscles in humans are in the lower limbs. It also means that the tendons attaching muscles to the bones of the legs must withstand enormous loads. But, unfortunately, there are unsuccessful movements, falls, provoking the stretching of the tendons on the leg.
Achilles tendon stretching occurs with insufficient warming up of muscles during sports activities, while wearing uncomfortable shoes, moving on an uneven, rocky surface. Stretching tendons can be divided into three degrees of difficulty:
- The first degree - a slight pain after injury, aggravated by physical exposure.
- The second degree - severe pain, swelling of the skin over the damaged tendon. Muscle weakness and increasing pain during exercise.
- Third degree - complete or partial tendon rupture, muscle contraction occurs. At the moment of rupture, there may be a feeling of clap, sharp, severe pain and swelling.
Usually, the third degree of tendon damage is restored by the operative method. Many victims of the first and second degree do not pay special attention to treatment and in vain, there may be a weakening of muscle strength, the development of inflammation in the tendon and in the “sheath” - where there are several of them. Basically, this phenomenon is observed in the tendons of the muscles of the foot and is called tenosynovitis.
Chronic inflammation is complicated by an atrophic process that affects the thinning of the tendon fibers, and they can be easily broken off at low loads. When stretching the tendons on the leg, first aid consists of immobilization, fixation in an elevated position. Then you need to apply ice for 20-30 minutes (repeat 4-5 times a day), after which each time apply a pressure bandage with an elastic bandage to limit the spread of puffiness.
Ice will stop bleeding from damaged vessels. Such pains as diclofenac, analgin, and ketans relieve severe pain. On the second day, after the removal of inflammation and edema, if there is no hematoma development, the next stage of treatment is applied, namely thermal procedures. From the effects of heat, the bloodstream normalizes and the damage heals. The use of anti-inflammatory ointments is effective, among which Finalgon, Efkamon, Voltaren have become popular.
The tendon recovers faster at rest, thanks to the use of products rich in animal and vegetable proteins. After a week, under the supervision of a specialist, with the help of a set of exercises, they gradually load the sore muscles. Mechanical damage results from the direct or indirect effects of a traumatic agent.
Direct action - blow with a blunt object. Indirect action - a sharp contraction of the muscles. There are closed lesions, among which there are gaps and much less sprains. Closed injuries include spontaneous breaks, usually they occur with chronic injury and dystrophic changes in the structure of the tendons. Also, the cause of the gap can be infectious-toxic and metabolic-toxic factors, for example, diabetes, arthritis, infectious diseases.
There are subcutaneous partial or complete breaks without damage to the skin. Dislocation of tendons as a result of rupture of ligaments, ends with hemorrhage, swelling and pain when moving a joint. The displacement is so strong that defects can be seen by visual inspection. Especially if it concerns the extensors of the fingers. Treatment of dislocation - its administration, immobilization with a plaster cast for 3-4 weeks.
Surgical intervention is indicated in case of long-standing and habitual dislocations, with constantly reminding of damage by pain syndrome, with an obvious change in functional activity. Tendon rupture usually announces itself with a loud crack, intolerable pain and impaired motor function of a ruptured muscle. Open injuries are observed when stabbed, chopped, chopped wounds, with severe injuries. Damage levels:
- Separation of the tendon from the point of attachment.
- Gap along the entire length of the tendons.
- A tendon rupture in the zone of its transition into the muscle. Such phenomena are most likely to occur in older people, and those whose profession is associated with muscle overvoltage or athletes.
Rupture and damage to hand tendons
Open injuries (stabbed, chopped, chopped wounds) are observed in case of severe injuries, for example, after the brush hits the working mechanisms at the production facilities. Damage to the tendons of the muscles of the upper limb is generally observed at the level of the hand and forearm, more often it is the flexors. Both individual injuries of the tendons are noted, as well as a combination with damage to the adjacent vessels and nerves.
When the hand is between the moving parts of the unit, its fragmentation happens, torn wounds are obtained, the muscles contract and the ends of the tendons diverge. As a result, the tendons are completely cut into wounds in the extremities. It requires surgical restoration. The operation is rather complicated and lengthy, because it is necessary to sew all the damaged tendons in order to normalize the function of the hand. Accelerates the process of healing the wound of the tendon overlay extensor dynamic splint.
Rupture and damage to the tendons of the fingers
When the tendons of the fingers rupture, it is possible to detect the absence of active flexion in the distal interphalangeal joints of the hand. This is evidence that a deep flexor is damaged. If the absence of active movements in the interphalangeal joints is determined, then the superficial and deep flexors of the fingers are damaged. But the function of the worm-like muscles, which provides active flexion in the metacarpophalangeal joints, may be preserved.
Investigating the sensitivity of the fingers, nerve damage is detected. The radiographic method for bruised and fractured wounds will definitely show the degree of damage to the bones and joints. Open injuries of flexor tendons are more common. If there is damage in the area of the distal interphalangeal joint, bending of the nail phalanx by 60 ° is possible, and extension is not feasible.
With the defeat of the tendon-aponeurotic stretching of the extensors of the fingers of the hand at the level of the proximal interphalangeal joint, even if the integrity of its central part is broken, perhaps the extension of the nail phalanx, sometimes the middle can be in the flexion position. A fairly common phenomenon is when the nail and middle phalanges are in a bent position with all three parts involved. The extensor of the finger can be damaged in the area of the main phalanx, then active extension in the joints between the phalanges takes place, but the activity of the extension of the main phalanx is not observed.
It is necessary to treat injuries of flexors and extensors of fingers of a hand surgically. The exception is fresh breaks in the distal interphalangeal joint, where fixation of the phalangeal hyperextension of the nail phalanx and flexion of the middle phalanx at a right angle for 1 to 1.5 months effectively helps.
As for open injuries, first aid is to stop the bleeding, after which it is desirable to cover the wound with a sterile dressing and apply a transport tire. The trauma center will clarify the diagnosis, treat the wound, make a tendon suture, which, by the way, is contraindicated for torn-bruised wounds, bone fractures and joint injuries. Modern surgeons recommend plastic surgery for chronic injuries of flexor tendons and extensors of fingers.
Rupture and damage to the tendons of the foot
The degree of damage to the tendons of the foot:
- First degree - slight pain, slight swelling of the ankle. You can step on the foot. Discomfort disappears after a few days of treatment with special ointments and compresses.
- The second degree is a medium-sized tumor of the joint, a sharp pain when moving with the foot.
- The third degree - tendon rupture, severe persistent pain, significant swelling of the joint.
Achilles or calcaneal tendon rupture and damage (triceps muscle), which is attached to the calcaneal tubercle and is very thick, appears as a result of strong tension. Usually the gap in this zone is complete. Causes of damage include direct injury after impact with a hard object and indirect effects resulting from a sharp contraction of the triceps muscle.
Athletes are at risk, injuries can occur, for example, in runners with a sudden strain on the tendon at the time of separation of the foot from the surface at the start, in athletes with a sharp back flexion of the foot during a fall from a height. Partial damage to the Achilles tendon occurs in direct injury to the cutting object. The victim has a sharp pain, a sensation of a blow to the tendon.
On the back of the lower third of the leg there is hemorrhage and swelling. In the area of the gap you can see a dent. The patient can not stand on the pads of the fingers, it is impossible plantar flexion of the foot. The provision of first aid consists of anesthesia with drugs and its delivery to the casualty department.
Treatment for fresh breaks (no more than two weeks) - closed percutaneous suture. A plaster cast is applied to the affected area for 4 weeks, the leg remains in one position all the time. After removing the thread from the seam, the leg is fixed for 4 weeks in a different position.
If the injury is old (more than 2 weeks), usually at the ends of the tendons the scar tissue is already formed, it is removed, a skin incision is made over the tendon, the ends of the tendon are stitched with a special suture according to Dr. Tkachenko's method. If there is a defect in the tissue, perform plastics with subsequent plaster cast for a period of 6 weeks. Full recovery is guaranteed when using special exercises and physiotherapy.
The Achilles tendon is the strongest, it stretches when the muscles are tensed and allows you to stand on the toe or jump. For the diagnosis using an x-ray of the ankle joint in the lateral projection, magnetic resonance imaging ultrasound equipment. Damage can also be determined by traditional palpation.
Rupture and damage to the tendons of the legs
On the legs there is a rupture of the tendon of the quadriceps muscle of the thigh. The tendon of the quadriceps muscle of the thigh is attached to the surface and lateral parts of the patella and tibial tuberosity. This is a very strong connection, but the muscle also has strength, therefore, from its sharp reduction, the tendon ruptures in the transverse direction at a site just below the attachment to the patella. At the moment of rupture, a crash is heard and a sharp pain over the knee is felt.
A retraction is formed, hemorrhage occurs, tissues swell. The quadriceps muscle loses its tone, its tension leads to a hemispherical protrusion. Attempts to extend the lower leg becomes unsuccessful. First aid - the imposition of tires and delivery to the hospital. For the treatment of the tendon rupture of the quadriceps muscle of the thigh, anesthetic therapy and stitching of the ends of the tendon with suture materials are used. Plaster cast is applied for 6 weeks. Then shows physiotherapy and physiotherapy.
Many people experience pain in the tendons of the legs, arms. Doctors state that they have to deal with such complaints daily in their practice.
Pathogenic processes in tendons, such as tendonitis, tendinosis and tenosynovitis are not uncommon. Tendinitis develops with incorrect posture, prolonged sitting in an uncomfortable position, in the absence of heating of the muscles during sports. Infectious diseases, arthritis of the joints and diseases of the musculoskeletal system, different lengths of the extremities increase the load on the muscles and tendons.
If there is pain in the tendons, then it is palpable in the adjacent tissues. Soreness may occur suddenly or gradually increase. Unbearable pain is characterized by the presence of calcium deposits, impaired mobility and capsulitis of the shoulder. Sharp pain is observed in tendinosis, because it is associated with a tendon rupture. Sore tendons and tenosinovit. The cause of the pain in the tendons may be an excess of the capacity of the organ. With prolonged exertion, tissue dystrophy develops, metabolism is disturbed.
Expert Editor: Pavel Alexandrovich Mochalov | D.M.N. general practitioner
Education: Moscow Medical Institute. I. M. Sechenov, specialty - “Medicine” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.
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Types of tendons
- short and long tendons
- wide, narrow, rounded, cord-shaped and ribbon-shaped tendons
- lamellar in the form of stretching - aponeurosis
- tendons in the form of bridges that divide the muscle into several sections, tendon arches stretched between two points of the bones
- centrally located tendons in the domed muscles (for example, the tendon center of the diaphragm, the tendon helmet of the supercranial muscle)
- in the digastric muscles there are intermediate tendons, the tendon can be located on the lateral surface of the body of the muscle, penetrate inside it
The course of the muscle fibers is parallel to the long axis of the muscle and tendon, or the muscle fibers are located at an angle to the longitudinal axis of the tendon, which changes the direction of the muscles and the transfer of the developed force. In the spindle-shaped muscles, her body at both ends, gradually narrowing, turns into a relatively narrow tendon, which ensures accurate transfer of muscle effort to the bone. In single and double-muscle muscles, the muscle fibers are located at an angle to the longitudinal axis of the tendon, as a result, the so-called physiological width of the muscle increases and its thrust force increases.
Tendons differ not only in shape, but also in structure depending on the surrounding tissue. Some tendons consist exclusively of tendon tissue. In a place of particularly high load (for example, in the area of the bends of the bones), a zone of fibrous cartilage forms in the thickness of the tendon (for example, in the tendon of the biceps of the shoulder in the radius). If the tendons slide along other tissues, especially bones, tendon sheaths are formed to reduce friction (the tendon bag of the triceps muscle between its tendon and the ulnar process).
Blood supply and innervation of the tendons
The tendon tissue, including its connective tissue components, is well supplied with blood and innervated. Vessels and nerves approach it through connective tissue shells (endotenonium, peri-tenonium, paratenonium) and are arranged parallel to the tendon fibers. In addition to extracorporeal, there are also intracranial vessels and nerves that anastomose with each other. In the area of the bone-tendon junction, they are connected to the vessels and nerves of the periosteum and bone. Anastomoses also form with the vascular and neural structures of the tendon sheaths. In the place of formation of fibrous cartilage in the tendon, tissue nutrition is performed avascularly, i.e. thanks to the processes of osmosis and diffusion. Tendons receive both vegetative and sensitive innervation (for example, through the Golgi receptors).
Blood and lymphatic vessels, nerves penetrate the tendon from the abdomen of the muscle or periosteum together attaching the tendon to the bone. The tendons of the muscles of the distal extremities differ in considerable length and, passing near the joints, they lie in the bone-fibrous canals. In these places, tendons can easily be injured. In the bone-fibrous canals, the tendons are enclosed in synovial vagina, which facilitates their sliding. In areas of greatest mobility and friction of the tendon on the bony protrusions, synovial bags can be placed to help reduce friction. In some tendons (for example, in the quadriceps muscle of the thigh) there are sesamoid bones that change the angle of attachment of the muscle and prevent the tendons from coming into contact with the articular surfaces.
Age changes of tendons
Age-related changes in tendons are associated with a certain disproportion in the development of muscle and tendon parts of muscles in ontogenesis. In the muscles of the newborn tendon is poorly developed. Up to about 15 years, the tendons and abdomen of a mouse grow equally intensively. From 15 to 23-25 years, the tendon part of the muscles grows faster. In old age, involutive changes lead to disorganization of tendon bundles and a decrease in tendon elasticity.
With age, the proliferative capacity of tendon cells decreases. The number of cells and the production of the basic substance are reduced, and the number of elastic and collagen fibers is also reduced. As a result, there is an age-related decrease in tensile strength and tendon tensile by approximately 20%. Also decreases the maximum allowable load on the tendon. Only with constant stimuli (tension and relaxation, i.e. during trainings) is it possible to maintain the strength of a constantly renewed tendon.
Impact training on tendons
With appropriate training, the strength of the tendons can even be improved. Adequate irritation of the tendon tissue leads to an increase in the activity of tenocytes and the synthesis of collagen and the main substance - the number of collagen fibrils and fibers increases and the diameter of the tendon increases.
Too large non-physiological loads, for example, in professional sports and even in amateur, can lead to the replacement of thick collagen fibers with thin ones, which leads to the formation of a more stable, but less elastic tendon. Too high loads can lead to partial ossification of the tendons due to the fact that tendon cells, like osteocytes (bone cells), can react with increased calcification. The strength of the tendon during ossification (ossification) decreases and the risk of rupture increases. With immobilization or insufficient load of the tendon (for example, with an inactive muscle) the amount of collagen and non-collagen fibers decreases.
Most often in outpatient practice, one has to deal with mechanical damage to the tendons as a result of a direct (for example, blow with a blunt object) or indirect (for example, sharp muscle contractiona) action of traumatic power.
There are closed and open tendon damage. Among the closed tendon injuries, there are sprains (rarely) and ruptures. A special group of closed tendon injuries is made up of their so-called spontaneous breaks, which usually occur against the background of chronic traumatization and dystrophic changes in tendon structure (for example, cystic) or the action of infectious-toxic and metabolic-toxic factors (diabetes, arthritis, infectious diseases, etc. ), which also lead to dystrophic and inflammatory changes in the tendons (microtrauma, tendovaginitis).
Dislocation of the tendon may occur as a result of the rupture of the apparatus holding it (ligaments). At the same time, hemorrhage, swelling, local pain, aggravated by the contraction of the corresponding muscle or with some passive movements in the joint, are noted. In some cases, the displaced tendon is clearly visible upon external examination, especially with muscle tension. In other cases, it can be determined by palpation.
Repeated injuries (displacements) of the tendons, especially against the background of congenital hypoplasia of the ligaments that hold it in the corresponding channel, or the walls of the channel itself (flattening), can lead to the formation of the usual dislocation of the tendon. Treatment of tendon dislocation includes its reposition, immobilization with a plaster cast for 3-4 weeks.
When chronic and habitual dislocations, accompanied by pain and significant dysfunction, surgery is indicated. The prognosis is usually favorable, but relapses are possible. A long-existing habitual or unaligned tendon dislocation can lead to a progressive dysfunction and spontaneous tendon rupture.
Tendon ruptures often occur in old age, in individuals whose profession is associated with constant muscle over-exertion, and long-term sports.
Breaks tendons without damaging the skin are called subcutaneous. They can be partial and complete. Depending on the level of damage, there is a separation of the tendon from the point of attachment (sometimes a bone fragment comes off at the same time), a rupture over the tendon (less common) and a tendon rupture at the site of its transition into a muscle.
A tendon rupture is usually accompanied by cracking, severe pain and impaired function of the corresponding muscle. Of the subcutaneous tendon ruptures of the upper extremities, the tendons of the short rotators of the shoulder, the biceps of the shoulder, and the lower extremities are damaged more often than the tendons of the quadriceps femoris and calcaneal (Achilles) tendons. Among the ruptures of the tendons of the hand and fingers, open ones predominate, but closed ones may also occur, for example ruptures of the extensor tendons at the site of attachment to the distal phalanx. Tendon ruptures are often combined with more severe injuries, such as dislocations, fractures.
Clinically, tendon rupture manifests dull pain, aggravated by muscle contraction, increasing swelling of the surrounding soft tissues and hemorrhage. With spontaneous tendon ruptures, pain may be virtually absent, swelling and hemorrhage are much less pronounced. It is characterized by a decrease in the tone of the muscle, the tendon of which is damaged, when it is strained, a hemispherical protrusion of a testovat consistency is formed. With complete rupture of the tendons, tissue retraction is noted (better defined after reduction of edema).
In all cases of damage to the tendons, the function of the corresponding muscle is impaired, with a complete break, it falls out completely. So, when breaking tendons of short shoulder rotators, full active abduction of the shoulder or its rotation is not possible, when breaking the tendon of the triceps muscle of the shoulder - extension of the forearm, when breaking the tendon of the quadriceps muscle of the thigh - extension of the lower leg.
In some cases, the synergistic muscles take over the function of the damaged one, which makes it difficult to diagnose, for example, when the tendon of the biceps of the thigh or the semi-tendinous muscle is broken, active flexion of the tibia is possible, since the integrity of the gastrocnemius, tailoring and other muscles is preserved; when breaking the heel tendon, the strength of the plantar flexion of the foot decreases, but it is possible due to the flexors of the toes, the posterior tibial, fibular muscles.
Unlike other injuries that are accompanied by impaired motor function, an isolated sensitivity disorder is not characteristic of isolated tendon ruptures, compression of the abdomen of the muscle is not accompanied by tendon tension, since its integrity is broken. To clarify the diagnosis, an x-ray examination is performed, with the separation of the bone fragment together with the tendon it is clearly visible on the radiograph. To clarify the level and extent of damage to the tendon using thermography and ultrasonography. When tendon ruptures are located inside the joints, arthroscopy provides valuable information.
Methods for the study of tendon damage
To identify the pathology of the tendons using the inspection, palpation perform passive movements, accompanied by stretching of the tendons (with diseases), active movements with the participation of the corresponding muscle. To clarify the diagnosis in some cases, conduct thermography, ultrasonography, less X-ray examination (for example, soft images) and biopsy. For intraarticular lesion of the tendons, arthroscopy is used.
Electron diffraction pattern of collagen fibers of the heel tendon. Scanning electron microscopy x 3000 times
Electron diffraction pattern of collagen fibers of the heel tendon. Scanning electron microscopy x 50 times
Treatment of tendon ruptures
Treatment of subcutaneous tendon ruptures depends on the location and nature of the injury.
For partial tendon ruptures, local anesthesia of the damaged area is usually performed and a plaster bandage or splint is applied to ensure immobilization in a position where the ends of the torn tendon come together, the duration of immobilization is about 6 weeks. Then prescribed physical therapy, massage, physiotherapy. Disability is usually restored after 2-3 months.
With complete tendon ruptures, treatment is usually operative. To restore the integrity of the tendons in the later periods after injury, when a scar has formed between its ends, an operation is also performed.
If there are contraindications, treatment of complete tendon ruptures may be conservative (similar to the treatment of partial tendon ruptures).However, in this case, a scar is formed at the site of the rupture, which increases the length of the tendon, which leads to functional insufficiency of the corresponding muscle. Thus, with the conservative treatment of a complete break of the heel tendon, lameness often remains due to the weakness of the muscles performing the plantar flexion of the foot, in almost all cases, the difficulty remains with walking fast, jumping and running, the patient cannot stand on the anterior part of the foot.
Treatment of spontaneous tendon ruptures can be both conservative and self-operative. The choice of method depends on the level of physical activity of the patient, the location of damage and the severity of dysfunction. Thus, separation from the place of attachment of the distal tendon of the biceps muscle of the shoulder significantly impairs the function of the arm, therefore, in most cases, surgery is shown, and the separation of the proximal tendon of the long head of the same muscle slightly impairs the function and gives only a cosmetic defect that has little effect on the function of the hand in everyday life . A fresh rupture of the tendons of short rotators of the shoulder is treated promptly, and in case of chronic infection, often even after surgery, the function is impaired.
Dynamometry provides valuable information to assess the degree of recovery of a function.