
Our bodies are a complex system of bones, muscles, tendons, and ligaments, all working together to enable movement and provide stability. Tendons are fibrous tissues that connect muscles to bones, acting as mechanical bridges and allowing for the transfer of movement from the muscle to the bone. They are made of strong collagen fibres, which make them resistant to tearing but not very stretchy. Tendons also contain blood vessels and nerves. This article will explore the role of tendons in the body and how they attach muscles to bones, as well as their composition and function.
| Characteristics | Values |
|---|---|
| What are tendons | Fibrous tissues that connect muscles to bones |
| Where do tendons attach to bones | At the osteotendinous junction (OTJ) |
| What are tendons made of | Collagen fibres, connective tissue, Sharpey fibres, blood vessels, nerves |
| What are tendon sheaths | Layers of connective tissue that protect tendons |
| Where are tendon sheaths found | In areas where tendons run through narrow tunnels of bone and ligaments, or over bumpy parts of bones, e.g. wrist and foot |
| What is the function of tendons | Transmit muscle forces to bones and joints, allowing movement and preventing muscle injury |
| How do tendons adapt | Tendons adapt to mechanical tension and stress, increasing in collagen synthesis and diameter |
| How does age affect tendons | Tendons become thinner, have reduced blood flow, accumulate microscopic damage, and decrease in regeneration capacity |
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What You'll Learn

Tendons are fibrous tissues
Tendons are made of connective tissue, with a high volume of strong collagen fibres. Collagen fibres are nonelastic and have variable bundle thicknesses. They are made up of closely packed thin collagen fibrils that run a wavy course in tissues. These parallel fibrils form bundles with flexible proteoglycans, offering an essential mechanical property. Collagen fibres offer flexible but powerful resistance to pulling force. Tendons are highly resistant to tearing but are not stretchy, which means they can be easily injured when strained and may take a long time to heal.
The hierarchical arrangement of collagen molecules in tendons arranges into collagen fibrils and then collagen fibres. Sharpey fibres, a type of collagen fibre, attach the tendon to the bone. The epitenon is a thin layer of connective tissue that surrounds the entire tendon. The paratenon is a loose layer of connective tissue that lets the tendon move against the epitenon and other tissues that the tendon touches.
Tendons have two areas of transition or junctions: the musculotendinous junction (MTJ) and the osteotendinous junction (OTJ). The MTJ is the point where the tendon attaches to the muscle, and the OTJ is the point where the tendon attaches to the bone.
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Tendons transmit muscle forces
Tendons are fibrous tissues that connect muscles to bones all over the body. They are made of strong collagen fibres, which are flexible and resistant to damage. Tendons allow limbs to move and prevent muscle injury by absorbing some of the impact of movement.
The collagen fibres in tendons are bundled and arranged in a way that is specific to the requirements of each tendon. For example, tendons that need to resist rotational forces will have collagen fibres oriented to enable this. Tendons are stiffer than muscles and have greater tensile strength, allowing them to withstand large loads with minimal deformation.
The capacity of tendons to transmit muscle forces decreases with age. Aging alters the cellular structure of tendons, diminishing their ability to regenerate and direct muscle forces toward bone tissue. Tendons become thinner, less organised, and more susceptible to trauma.
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Osteotendinous junction (OTJ)
Tendons are fibrous tissues that connect muscles to bones all over the body. They are made of strong collagen fibres, which makes them resistant to tearing but not very stretchy. They are also prone to injury when overstrained and can take a long time to heal.
The Osteotendinous junction (OTJ) is the point where the tendon attaches to the bone. The Sharpey fibres, which are part of the tendon, extend into the bone. The tendon-bone junction typically lacks nerves, yet a loss of innervation in the rest of the tendon can lead to chronic tendinopathies, especially near such junctions.
The OTJ has a complex vascular supply. Blood vessels supplying the tendon may originate from the muscle belly, the periosteum around the osteotendinous junction, or the vascular networks within peritendinous leaflets or synovial sheaths. Peritendinous leaflets' circulatory networks vary within and between tendons. These networks may feature primary trunks forming either a mesh structure or irregularly arranged concentric arches, with small to medium-sized arteries and one or two satellite venous connections.
Some tendons run through narrow tunnels made of bones and ligaments, and some are stretched over bumpy parts of bones, as in the wrist and foot. In these places, the tendons are often protected by layers of connective tissue known as tendon sheaths. Tendon sheaths are filled with a lubricating fluid, allowing the tendons to move smoothly and freely through them.
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Tendons have a complex vascular supply
Tendons are fibrous tissues that connect muscles to bones, allowing the body to move. They are made of connective tissue that contains strong collagen fibres, making them resistant to tearing but not very stretchy. Tendons have a complex vascular supply, which will be discussed in further detail in the following paragraphs.
Tendons have a limited blood supply, receiving vascular supply from segmental vessels that extend from the forearm to the midportion of the proximal phalanx. The blood supply to tendons varies depending on their shape and whether they are contained within a sheath. For example, the rotator cuff tendons are supplied by six arteries, while the Achilles tendon is supplied by branches of the peroneal and posterior tibial arteries.
The vascularisation of tendon grafts is crucial for their function. While there has been some examination of the source of blood vessels and the timeline of vascularisation, the cellular factors mediating this process are not well understood. Tendons consist of tendon cells called tenoblasts and tenocytes, which make up approximately 90-95% of the cells within the tendon. The remaining 5-10% include chondrocytes, synovial cells, and vascular cells.
The collagen fibres in tendons contribute to their tensile strength and flexibility. The orientation of these fibres can vary, running parallel, crossing, or in a plait formation. As tendons age, the diameter of the collagen fibre bundles decreases, potentially leading to decreased muscle strength. This reduction in diameter has also been observed in injured tendons.
The role of vasculature in the healing process of damaged tendons is significant. Histopathologic studies of the patellar tendon have shown capillary proliferation and angiogenesis in the degenerate region. Neovascularisation in chronic tendinopathy has been linked to clinical symptoms such as pain and swelling. Additionally, vascular alterations in the paratenon can disturb the blood supply, resulting in ischemic pain during exercise.
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Tendons are prone to injury
Tendons are fibrous tissues that connect muscles to bones, allowing for joint movement and limb flexibility. They are made of strong collagen fibres, which makes them highly resistant to tearing but not very stretchy. This means that they are prone to injury when strained or overused, and they take a long time to heal. Tendons are stiffer than muscles and have great strength; for example, the flexor tendons in the foot can handle more than eight times the body weight of a person.
Tendons are susceptible to degeneration and injury due to several factors. Firstly, overuse or mechanical overuse can lead to tendon injuries. Repetitive activities or tensile loading can cause microdamage to the tendon, increasing the risk of tendinopathy or rupture. Tendons have to withstand tremendous forces during repetitive motions, making them vulnerable to overuse injuries.
Age-related degeneration is another common cause of tendon injuries. As people age, tendons become thinner, have reduced blood flow, and accumulate microscopic damage that weakens them over time. Certain health conditions, such as arthritis, can also contribute to tendon degeneration and injury.
Additionally, the structure and placement of tendons can make them more prone to injury. Some tendons run through narrow tunnels of bones and ligaments, while others are stretched over bumpy parts of bones, such as in the wrist and foot. These anatomical configurations can increase the risk of tendon injuries in certain areas.
To prevent tendon injuries, it is essential to maintain a balanced exercise routine that includes cardio, strength training, and flexibility work. This helps to avoid overtaxing specific tendons and can reduce the likelihood of tendon problems.
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Frequently asked questions
Tendons connect muscles to bones, allowing us to move.
Tendons are made of connective tissue that has a lot of strong collagen fibres in it. This makes them resistant to tearing but not very stretchy.
Tendons attach to bones at the osteotendinous junction (OTJ). The Sharpey fibres that are part of the tendon extend into the bone.
Tendon issues are more common with age. As people get older, tendons become thinner, have less blood flow and accumulate microscopic damage to fibres that weaken the tendon.











































