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Tendon Rupture – Causes, Symptoms and Treatment

A tendon rupture is the complete or partial tearing of a tendon, often caused by injury or overuse. It leads to sudden pain, swelling, and loss of movement in the affected area.

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Things worth knowing about "Tendon Rupture"

A tendon rupture is the complete or partial tearing of a tendon, often caused by injury or overuse. It leads to sudden pain, swelling, and loss of movement in the affected area.

What Is a Tendon Rupture?

A tendon rupture, also called a tendon tear or tendon avulsion, is the complete or partial separation of a tendon from its attachment to a bone or within the tendon tissue itself. Tendons are strong, fibrous connective tissue structures that connect muscles to bones, enabling movement. When a tendon ruptures, the transmission of muscle force to the bone is disrupted, resulting in significant loss of function.

Causes

Tendon ruptures can occur due to several different factors:

Acute trauma: A sudden, forceful load on the tendon, such as during sports or a fall.
Chronic overuse: Repetitive stress over time gradually weakens the tendon structure.
Degeneration: As tendons age, they lose elasticity and become more susceptible to tearing.
Underlying conditions: Diseases such as rheumatoid arthritis or diabetes, as well as certain medications (e.g., corticosteroids or fluoroquinolone antibiotics), can weaken tendon tissue.
Direct injury: Cuts or crushing injuries can directly sever tendons.

Commonly Affected Tendons

Achilles tendon: The most frequently ruptured tendon, commonly seen in athletes.
Rotator cuff: Tendons of the shoulder, particularly in older individuals or those with repetitive overhead activity.
Biceps tendon: At the shoulder or elbow joint.
Quadriceps and patellar tendons: At the knee joint.
Finger tendons: Often caused by cuts or sports injuries.

Symptoms

Symptoms of a tendon rupture vary depending on the affected tendon, but common signs include:

Sudden, sharp pain in the affected area
An audible or felt snapping or popping sensation at the moment of injury
Swelling and bruising (hematoma)
A visible gap or indentation in the area of the ruptured tendon
Severely limited or absent movement of the affected joint or muscle group
Loss of strength in the affected limb or body part

Diagnosis

The diagnosis of a tendon rupture is established through a combination of clinical examination and imaging:

Physical examination: The doctor assesses pain, range of motion, and strength. Specific tests, such as the Thompson test for the Achilles tendon, help confirm the diagnosis.
Ultrasound: A fast and cost-effective method to directly visualize the tendon and identify the tear.
Magnetic resonance imaging (MRI): Provides detailed images of tendon structures and surrounding tissue; considered the gold standard in ambiguous cases.
X-ray: Used to rule out accompanying bone fractures.

Treatment

Conservative Treatment

For partial tendon tears or patients with elevated surgical risk, conservative management may be appropriate:

Immobilization of the affected area using splints or plaster casts
Ice application and elevation to reduce swelling
Pain-relieving and anti-inflammatory medications
Physiotherapy to restore strength and range of motion

Surgical Treatment

For complete tendon ruptures or when full restoration of function is required, surgery is often recommended:

Tendon repair (suture): The torn ends of the tendon are sewn back together.
Tendon reconstruction: In cases of older or severely degenerated tears, tendon grafts or rerouting procedures may be necessary.
Surgery is followed by intensive physiotherapy as part of a comprehensive rehabilitation program.

Recovery and Prognosis

The recovery time depends on the specific tendon involved, the extent of the tear, and the chosen treatment approach. Full rehabilitation typically takes several months. With early and consistent treatment, the prognosis is generally good, and most individuals can return to their normal activities. However, the risk of re-rupture exists if the tendon is not given sufficient time to heal properly.

References

Maffulli, N., Khan, K. M., Puddu, G. (1998): Overuse tendon conditions: time to change a confusing terminology. Arthroscopy, 14(8), 840-843.
German Society for Orthopaedics and Trauma Surgery (DGOU): Clinical Guideline on Achilles Tendon Rupture. AWMF Registration No. 012-004.
van der Linden, P. D. et al. (2003): Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ, 322(7298), 1302-1305.

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