A tendon is the fibrous tissue that attaches muscle to bone in the human body. The forces applied to a tendon may be more than 5 times your body weight. In some rare instances, tendons can snap or rupture.
Although fairly uncommon, a tendon rupture can be a serious problem and may result in excruciating pain and permanent disability if untreated. Each type of tendon rupture has its own signs and symptoms and can be treated either surgically or medically depending on the severity of the rupture and the confidence of the surgeon.
The 4 most common areas of tendon rupture are as follows:
Quadriceps:
This group of 4 muscles come together just above your kneecap often called the quads, this group of muscles is used to extend the leg at the knee and aids in walking, running, and jumping.
Achilles:
This tendon is located on the back (posterior) portion of the foot just above the heel. It is the site of attachment of the calf muscle to the heel of the foot.This tendon is vital for pushing off with the foot .The Achilles helps you stand on your tiptoes and push off when starting a foot race.
Rotator cuff:
Your rotator cuff is located in the shoulder and is actually composed of 4 muscles. This group of muscles functions to raise your arm out to the side, helps you rotate the arm, and keeps your shoulder from popping out of its socket.The rotator cuff tendon is one of the most common areas in the body affected by tendon injury.
Biceps:
The biceps muscle of the arm functions as a flexor of the elbow. This muscle brings the hand toward the shoulder by bending at the elbow. Ruptures of the biceps are classified into proximal (close) and distal (far) types. Distal ruptures are extremely rare. The proximal rupture is at the attachment of the biceps at the top of your shoulder
Ruptured Tendon Causes
In general, tendon rupture occurs in a middle-aged or older man. In the young, muscle usually tears before the attached tendon will tear. The tendons may get ruptured also due to accidents, decreased blood supply to the tendon, increased stress on the involved tendon and in some cases steroids injection into tendon.
Quadriceps tendon rupture
Direct trauma (accident / injury) to the knee just above the kneecap.
Advanced age resulting in decreased blood supply to the inside of the tendon.
Stretching of the muscle.
Achilles tendon rupture:
Advanced age resulting in decreased blood supply to the inside of the tendon
Strenuous physical activity by those not in great health overall.
Direct trauma. (accident /injury)
Unexpected forcing of the sole of your foot upward as in landing on your feet after jumping from a height
Excessive strain while pushing off with weight bearing foot
Rotator cuff tendon rupture:
Lifting a heavy object overhead
Direct trauma. (accident / injury)
Attempting to break a fall with an outstretched hand
Biceps tendon rupture
Forced flexion of the arm
Traumatic rupture usually occurs when lifting 150 pounds or more
Advanced age resulting in gradual weakening of the tendon
May occur spontaneously
Ruptured Tendon Symptoms General Symptoms of Tendons Injury are:
An injury that is associated with the following signs or symptoms may be a tendon rupture.
A snap or pop you hear or feel
Severe pain
Rapid or immediate bruising
Marked weakness
Inability to use the affected arm or leg
Inability to move the area involved
Inability to bear weight
Deformity of the area
Symptoms associated with specific injuries
Achilles tendon rupture: You will be unable to support yourself on your tiptoes on the affected leg (you may be able to flex your toes downward because supporting muscles are intact).
Rotator cuff rupture: You will be unable to bring your arm out to the side.
Biceps tendon rupture: You will have decreased strength of elbow flexion and decreased ability to raise the arm out to the side when the hand is turned palm up.
Seeking Medical Care:
Visit the hospital's emergency department whenever an injury occurs that produces severe pain and is accompanied by a pop or snap. Weakness, inability to move the area involved, inability to bear weight, and deformity of the area are other key symptoms that require a visit to the emergency department.
Because you know your body the best, if something appears to be serious to you, it is usually the best course to be conservative and have an evaluation.
Ruptured Tendon Treatment
Medical Treatment
Quadriceps:
Partial tears may be treated without surgery by placing your straight leg in a cast or immobilizer for 4-6 weeks.Once you are able to raise the affected leg without discomfort for 10 days, it is safe to slowly stop the immobilization.
Achilles tendon:
Treatment without surgery involves placing your foot so that the sole of the foot is pointed downward for 4-8 weeks.
Rotator cuff:
The rotator cuff is unique because treatment without surgery is the treatment of choice in most tendon injuries.
Biceps:
Most surgeons prefer not to operate on a ruptured biceps tendon because function is not severely impaired with its rupture. This is considered to be a moderate loss and not worth the risk of surgery in middle-aged and older people.
Surgery Options:
Quadriceps:
Unless the doctor is sure that the injury is a partial tear, surgery will be done to repair the tendon.
After your operation, you will be placed in a cast or immobilizer as if you had a partial tear.
With physical therapy, your injured leg should be up to speed with your non injured leg in 6 months.
Achilles tendon:
Surgery to repair your Achilles tendon is recommended for active people who desire near normal strength and power . An additional advantage with surgical correction is a lower re-rupture rate of the tendon.
After your operation, your foot will be immobilized with your toes pointing downward for 3-4 weeks and then progressively brought into neutral position over 2-3 weeks before weight bearing is started.
Rotator cuff:
Many surgeons will not attempt surgical repair until non operative treatment has failed, even in cases of larger tears.
Surgical treatment is usually reserved for a severe tear in a young person or in an older person (aged 60-70 years) who is suddenly unable to externally rotate their arm.
Biceps:
In young people unwilling to accept the loss of function and mild deformity involved with this injury, surgery is performed to repair the tendon.
Surgery is also considered for the middle-aged person who requires full supination strength in their line of work.
You should leave your arm in a sling for a few days after surgery and then begin to use the affected arm as tolerated. After surgery, your elbow flexion and arm supination is near normal in about 12 weeks.