Muscles, Tendons and Ligaments Care

The tissues involved and how they are injured

Muscles generate movement. Tendons are the cords that transmit that force from muscle to bone. Ligaments connect bone to bone and hold joints within a safe range of motion. Because they work as one system, an injury to any part changes how the others behave, which is why a torn ligament can leave a joint feeling unreliable long after the pain settles.

Injuries arrive in two broad patterns. Acute injuries follow a single event: a twist, a fall, a rapid change of direction, a direct blow, or a sudden load on a muscle already stretched. A strain refers to injury of muscle or tendon and a sprain to injury of a ligament, and either can range from a stretch of the fibers to a complete tear. Overuse injuries develop through repetition, when tissue is loaded more often than it can adapt to, and tendon problems of this kind are common around the shoulder, elbow, hip, knee and heel. Our page on ligaments, cartilage and meniscus describes knee injuries in more detail.

Symptoms that often bring people in

• Pain that began with a specific movement, twist, fall or collision
• Swelling or bruising over a joint or along the length of a muscle
• A joint that feels loose, unstable, or that gives way
• Weakness, or inability to lift the arm or straighten the knee
• Pain that builds after activity, settles with rest, then returns
• A pop or snap felt at the moment of injury

How soft tissue injuries are evaluated

Much of the information comes from the history and physical examination. How the injury happened, what position the limb was in, and what you could and could not do afterward all narrow the possibilities. Examination assesses swelling, the point of tenderness, strength against resistance, and the stability of the joint under controlled stress, usually comparing the uninjured side. X-rays do not show soft tissue directly but are often obtained to look for an associated fracture. MRI is the study most commonly used to see these tissues.

Treatment options in general terms

A great many soft tissue injuries are treated without surgery, and non-surgical care is usually structured rather than passive.

• Activity modification and protection. Adjusting loading, sometimes with a brace, splint or boot, so the tissue is not repeatedly re-injured.
• Physical therapy. A graded program to restore motion, rebuild strength through the whole chain, and address the mechanics that contributed to the injury.
• Injection based options. Where appropriate, options including platelet rich plasma may be discussed as part of a non-surgical plan.

Surgery may be considered when a tendon or ligament is completely torn, when a joint remains unstable, or when symptoms persist despite a fair trial of non-surgical care.

• Repair. Torn tissue is reattached to bone or sewn back together, an approach used for many tendon and some ligament injuries.
• Reconstruction. Where the original tissue cannot be repaired, a graft may be used to rebuild a ligament and restore stability.
• Arthroscopic techniques. Many of these procedures can be performed through small incisions using a camera.

What to expect when you consult Dr. Wolfson

Dr. Wolfson treats professional and recreational athletes as well as patients whose injuries happened at work or at home, and as a former competitive athlete himself he takes seriously what you are trying to get back to. A consultation typically covers the mechanism of your injury, examination of the joint, a review of any imaging, and whether non-surgical care is a reasonable starting point. Where joint surface damage is part of the picture, see our page on cartilage restoration.

This page provides general information about muscle, tendon and ligament injuries and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]