Tendon & Ligament Center

Tendons and Ligaments are an integral part of the musculoskeletal system.  Tendons connect muscle to bone and without them we could not play sports or walk.  Tendons are connective tissue made from extremely strong and flexible collagen.  Since they connect muscle to bone, they can withstand high levels of tension.   These are similar to ligaments but ligaments connect bone to bone to help with joint stability.

Overuse injuries (including tendon and ligaments) account for 7% of all doctor visits in the USA.

Tendon injuries are all too common and some have difficulty healing, which can lead to chronic pain. Overuse injuries (including tendon and ligaments) account for 7% of all doctor visits in the USA.

For a long time, chronic painful tendons have been called “tendonitis.”  Recently, histologic biopsies have shown that they do not show signs of inflammation but show poorly ordered collagen with elevated proteoglycan ground substance.  Ultrasound imaging can show signs of tendon damage with increased neovascularization, increased tendon disorganization, tendon thickening and tears. Chronic tendon pain can set in after a tendon injury fails to complete the healing cycle and tendon degeneration occurs.  A more appropriate term has been given for this condition called “tendinopathy” or “tendinosis.”

Common Sites for Tendon Pain and Injury:

Ligaments can be injured as well. Typically, ligament injuries can be categorized in:

Grade I

– Minor Sprain

Grade II

– Severe Sprain or Partial Tear

Grade III

-Complete Disruption of Ligament

Grade I and II are most common and typically can be treated with conservative care and rehabilitation.

Grade II (partial tears) can be treated conservatively however new treatments have emerged in which we can treat these partial ligament tears with cellular treatments such as PRP.  Common ligament tears treated include MCL, LCL, UCL, and RTC tears. 

Common Sites for Ligament Injuries:

  • MCL
  • LCL
  • ACL laxity/partial tear
  • ATFL
  • Sacral ligaments
  • Interspinous process ligaments
  • UCL in elbow
  • Cervical Whiplash

General Diagnostic Approach

Physical exam, Ultrasound and MRI can be helpful in diagnosing tendinopathy.   Imaging can help determine the extent of the injury (tears) or tendon degeneration.  MRI is useful, but often ultrasound can be more accurate for diagnosis and it also can help guide treatment for needle placement. 

Conservative Treatment Options

Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and physical therapy with eccentric strengthening exercises.  Laser therapy can also be used.

Injected corticosteroids also can relieve pain, but these drugs should be used with caution as they have been shown to possibly weaken tendon by decreasing stem cell activity. We most commonly do not recommend these to be used for tendon issues.

Modern treatments for tendon and ligament injuries include physical therapy, prolotherapy, platelet rich plasma, and stem cell treatments. Ultrasound can now be used to precisely deliver treatment to a specific portion of the tendon or ligament that in injured with a tear or chronic tissue changes.  This is what we specialize in at Houston Spine & Sports Medicine. Let us help you work on a treatment program customized for your specific tendon or ligament condition.