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Muscle, Tendon, & Ligament pain and injury
Muscles, tendons, and ligaments span throughout our bodies to provide mobility, flexibility, and help support our joints. These soft tissues are highly susceptible to traumatic and overuse injuries not only during sports but simple everyday activities.
Muscles and tendons are common sources of pain and injury. Muscles help to produce movement that occurs at the joints. They are connected to the bones of the joints by tendons. When a muscle contracts, it pulls on the tendon to produce movement at a joint. Muscle and tendon pain may occur due to trauma or injury or it may occur gradually over time. Tendon injury is common in overuse situations (like distance runners, weight lifters, tennis players, etc.). Tendinopathy is pain and injury of a tendon. The early stages of tendon irritation and inflammation is called tendonitis. When this phase resolves, the tendon enters a phase of remodeling and healing that can last for weeks. If this process is not allowed to take place and repeated injury occurs there may be disruption to the healing process and the injury is called tendinosis.
VSMD Approach
At VSMD, we diagnose injury and issues to muscles, tendons, and ligaments by analyzing medical history, conducting a physical exam, and using imaging such as ultrasound. Based on the findings, the doctor may recommend a conservative treatment to reduce pain and swelling and allow the soft tissue to heal properly. In case of a tear or major strain, the doctor may prescribe a more involved approach to initiate the healing process.
For most issues, a non-surgical regiment with frequent evaluation by the doctor is the best course. At VSMD, we treat each patient through a holistic lens. Our doctors not only evaluate the muscles, tendons, and ligaments but also the accompanying systems.
Causes of Muscle, Tendon, and Ligament Pain and Injury
Impact and strain to our soft tissues is a major cause of pain and injury. The issues can occur not only during sports and exercise but also during everyday activities. Below are some common injuries and conditions that affect the muscles, tendons, and ligaments.
We treat the following conditions:
Muscle Contusion (Bruise)
Common forms include – Quadriceps Contusion (Thigh bruise) and Biceps contusion.
A muscle bruise, also called contusion, occurs due to direct impact or tearing of a muscle. The quadriceps, or thigh muscles, are the most commonly bruised muscles due to being hit in the thigh. It is most common in football and soccer.
Myositis Ossificans
Myositis ossificans is when a muscle bruise does not heal all the way and bone tissue (calcium) forms within the muscle. This may occur when a muscle is not allowed enough time to heal or repeated injury occurs to the same area after initial injury. Myositis ossificans most commonly occurs in the thigh and hamstring muscles. It can occur in a variety of contact sports where the athlete is at risk of muscle bruise.
Muscle Cramps
Muscle cramps, commonly called “charley horse” is a painful, involuntary contraction of a muscle. It is not well understood why a muscle cramp occurs but a few theories exist and include electrolyte imbalance (sodium, potassium, calcium, and magnesium), micro trauma, fatigue, and heat illness. The most common muscles to experience cramping are the quadriceps, hamstrings, and calf muscles. The cramps often occur during or after extraneous activity or overuse of the muscle and sometimes resulting in pain and soreness.
Muscle Strain
Common forms include – Hamstring strain, Calf strain, Biceps and Triceps strain, Neck strain (cervical strain), and Rotator cuff strain.
Muscle strain can occur when a muscle is overstretched or overworked. It typically presents as pain in a certain muscle or group of muscles and may have a sudden or gradual onset. Risk factors include older age, higher levels of competition, previous history of strain, strength imbalances, poor flexibility, muscle fatigue, and inadequate warm-up. Muscle strain can happen to any muscles. Athletes of different sports are more likely to have muscle strain in particular muscles than others (e.g., soccer players are more likely to strain the quadriceps or hamstring muscles of the leg whereas a baseball player is more likely to strain the biceps muscle of the arm).
Rhabdomyolysis
Rhabdomyolysis is a condition in which muscles are subjected to extreme stress or use causing breakdown of the muscle fibers. When the muscles start to break down, muscle contents (like electrolytes and fiber products) are released into the bloodstream and affect the whole body. Rhabdomyolysis is a potentially life-threatening syndrome and if not treated can have devastating results. Athletes at risk of developing rhabdomyolysis commonly participate in extreme sports (weight lifting, distance running, football, soccer, basketball) or train and compete in extreme conditions (like high temperatures). Other risk factors for developing rhabdomyolysis include physical exertion in untrained athletes, heat illness or heat stroke, long periods of immobilization, lightning strikes, certain medications, and sickle cell disease. Rhabdomyolysis symptoms may include muscle pain, tea-colored urine, weakness, dehydration, fever, exhaustion, and fatigue.
Ligament Injury
Ligaments are fibrous connective tissue that provide support between two bones. Ligaments are prone to stretching and tearing injury both in sports and in daily activities. A ligament injury is often referred to as a sprain (ankle sprain, thumb, sprain, etc.) Some of the more well known ligament injuries include ACL and MCL injuries of the knee, UCL injury of the thumb and elbow, and ATFL injury of the ankle. Symptoms of ligament injury may include pain and swelling in the area, bruising, and limited range of motion.
Chronic Exertional Compartment Syndrome
Chronic exertional compartment syndrome (CECS) is one cause of exercise-related pain. There are muscle compartments in the legs and arms. Each compartment has a barrier that is surrounded by fascia- a thin layer of tissue that surrounds muscles. The compartments contain muscles, nerves, and blood vessels. During exercise, muscles swell and fluid enters the compartment spaces. If this compartment becomes too “full” it can restrict blood flow to the muscle and nerves within that compartment. This results in pain and other symptoms like tingling or decreased sensation.
Men and women athletes are equally affected by the problem. Athletes often get CECS in both legs. It is more common in running sports, basketball, gymnastics, soccer, field hockey, and dance.
Pain from CECS is typically made better by rest and increases with activity. If the problem is not addressed by consulting a doctor and the compartment is continually exercised, even through painful conditions, pain may become severe and significant damage to muscle and nerve tissue may result.
Tendonitis
Common forms include – Achilles tendonitis, Lateral epicondylitis (Tennis Elbow), Medial epicondylitis (Golfer’s Elbow), and Rotator Cuff tendonitis.
Tendonitis typically occurs due to overuse or overstretching a tendon or muscle-tendon unit. The early stages of tendon irritation and inflammation is called tendonitis which is followed by a phase of remodeling and healing. When the remodeling phase is interrupted, such as with repeated injury, the tendon may not appropriately heal and is called tendinosis. This problem commonly affects major tendons like the achilles tendon, tendons around the elbows (extensor and flexor tendons that move the wrist such as Golfer’s and Tennis elbow), and the rotator cuff tendons. Pain may start suddenly or gradually worsen over time. Pain can decrease motion and use of the tendon and joint nearby.
De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is an overuse injury characterized by thickening and swelling of the tendons that run from the base of the thumb to the wrist and forearm. The tendons involved move the thumb away from the hand. Most commonly, it occurs in people in their 30s – 50s, and occurs in women more frequently than men. It is most common in athletes who participate in sports with repetitive hand and wrist movements, like racket sports and golf.
Symptoms of de Quervain’s may include pain in the wrist or thumb made worse by movement. They may complain of pain while gripping or hitting, such as while playing golf, tennis, weight lifting, or rowing. They may also have swelling at the base of their thumb, decreased movement of the wrist and thumb, and sense their thumb sticking or locking with movement.
Trigger Finger and Trigger Thumb
Trigger finger is when the finger gets caught or stuck in the bent position. Straightening the finger will typically cause a snapping or popping such as when a trigger is released. Trigger finger occurs due to irritation and inflammation of a finger flexor (bending) tendon. When the tendon becomes inflamed, the finger is unable to have a smooth motion and produces the triggering. This typically is painful. Risk factors for trigger finger include repetitive or heavy use of fingers and hands and medical conditions like diabetes, thyroid disease, and rheumatoid arthritis. Trigger finger is most common in the ring finger, followed by the thumb.
Bursitis
Bursitis is a musculoskeletal condition that can occur in different areas of the body and is characterized by pain and swelling. A bursa is a fluid filled sac that cushions and protects bony prominences. Bursitis occurs when the bursa, or lining of the fluid-filled sac, becomes inflamed. When the bursa is inflamed, it can accumulate fluid which results in a lump that you can feel and even see over a bony prominence.
Common bursitis areas are: trochanteric (hip) bursitis, olecranon (elbow) bursitis, pre-patellar (knee) bursitis, pre-anserine (below the knee) bursitis, and retrocalcaneal (heel) bursitis.
Bursitis can be diagnosed in office by a sports medicine physician with or without imaging. The physician will obtain history information from the patient about how the painful area started, location, and activities. A physical exam may include range of motion testing, palpation of the painful and swollen area, and functional testing. Ultrasound evaluation may be useful to evaluate the surrounding area, joint, and bursa itself. You should tell your doctor if you have severe pain, fever, red or hot to touch skin as these may indicate a different diagnosis.