Tendon adhesions occur when the body’s natural healing process produces excessive or disorganized scar tissue that binds the tendon to its sheath or other nearby structures. Tendons are strong, fibrous tissues that connect muscle to bone. These structures must be able to glide smoothly past surrounding tissues for joints to bend and straighten without restriction. This restrictive tissue acts like glue, limiting the smooth gliding motion and significantly impairing the function of the joint the tendon controls.
The Formation and Symptoms of Tendon Adhesions
The formation of an adhesion is a consequence of the body’s inflammatory response to injury or trauma. When a tendon is damaged, such as from a severe laceration, a crush injury, or surgical repair, the site floods with cells to begin the repair process. This healing involves the deposition of new collagen fibers to bridge the injured area.
However, if the healing environment is disrupted, or if there is prolonged immobilization, this repair process can become disorganized and overzealous. The resulting fibrotic tissue extends beyond the injury site and tethers the tendon to the surrounding peritendinous tissues or the tendon sheath. This scar tissue inhibits the tendon’s ability to slide, leading to the physical symptoms experienced by the patient.
People with tendon adhesions typically experience pronounced stiffness and a restricted range of motion in the affected joint. They may possess a good passive range of motion, where the joint can be moved by an outside force, but have a severely limited active range of motion, which is the movement generated by the muscle itself. This discrepancy between active and passive movement is a strong indicator of a tethering adhesion, often accompanied by pain that intensifies when the individual attempts to move the joint through the restricted range.
Identifying Adhesions and Common Locations
Confirming the presence of a tendon adhesion begins with a thorough clinical examination. A physician will compare the active range of motion against the passive range of motion. A significant difference between the two motions suggests the tendon is stuck and unable to glide fully.
Diagnostic imaging is then used to visualize the restricted tissue and confirm the diagnosis. High-resolution ultrasound or magnetic resonance imaging (MRI) can provide detailed images of the soft tissues, allowing clinicians to see the scar tissue binding the tendon. These imaging techniques help to differentiate adhesions from other issues like tendon rupture or joint contracture.
Adhesions are common in areas where multiple tendons move through narrow anatomical tunnels. The flexor tendons of the hand and wrist, especially in the finger’s “no man’s land” (Zone II), are frequently affected due to the complex anatomy of the tendon sheath. Other common sites include the Achilles tendon area following injury or repair, and the tendons of the shoulder’s rotator cuff after surgical procedures.
Treatment Pathways for Restoring Movement
The initial approach to managing tendon adhesions is conservative, focusing on physical therapy and specialized mobilization techniques. A physical or occupational therapist will prescribe a regimen of specific stretching and gliding exercises designed to gently tension and lengthen the scar tissue. These exercises aim to encourage the tendon to break free from its attachments and restore smooth gliding within the sheath.
Deep tissue massage and manual therapy techniques are also used to mobilize the scar tissue and surrounding soft tissues. The goal is to mechanically disrupt the disorganized collagen fibers and improve the overall tissue flexibility. In some cases, specialized techniques like ultrasound-guided hydrodissection may be employed, which involves injecting fluid near the tendon to mechanically separate it from the surrounding adhesion.
When conservative management fails to restore functional movement after several months, a surgical procedure called tenolysis may be considered. Tenolysis involves a surgeon meticulously entering the area and physically separating the scar tissue that is binding the tendon. The procedure is often performed as an outpatient surgery and aims to restore the necessary gliding space around the tendon.
Immediate and aggressive rehabilitation is necessary following tenolysis to prevent the new formation of scar tissue. Post-surgical therapy protocols start within a day or two and are the most important factor for a successful outcome. This intensive regimen of controlled motion is essential to maintain the separation achieved during surgery and ensure the tendon heals with maximal excursion.
Strategies for Minimizing Adhesion Risk
The most effective strategy for minimizing the formation of restrictive adhesions is early, controlled mobilization following injury or surgery. Movement, often described as “motion is lotion,” helps to align the healing collagen fibers in a direction that supports tendon gliding, rather than allowing them to form disorganized cross-links that tether the tendon. This early motion must be carefully prescribed by a therapist to prevent re-injury or rupture of the healing tendon.
Adhering strictly to the post-operative rehabilitation protocol provided by the surgeon and therapist is important for risk reduction. These protocols are specifically designed to balance the need for protected healing with the imperative for movement. The controlled stress applied through specific exercises promotes intrinsic healing within the tendon, reducing reliance on the extrinsic healing processes that contribute to adhesion formation.