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Ruptured Tendon

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Exams and Tests continued...

Rotator cuff

  • You will be unable to initiate bringing your arm out to the side.
  • Your doctor may do a drop arm test. In this test, your arm is passively raised to 90°, and you are asked to hold your arm at this position. If you have rotator cuff rupture, slight pressure on the forearm will cause you to suddenly drop the arm.
  • X-rays may show that the long bone in your upper arm (the humerus) is slightly out of place.
  • Shoulder arthrography is most helpful in identifying a suspected rotator cuff tear. In this test, a dye that shows up on X-rays is injected directly into the shoulder joint, and the joint is then moved around. Then an X-ray of the shoulder is taken. If any dye is seen leaking from the joint, then it is highly likely that you have a ruptured rotator cuff.
  • MRI provides a noninvasive means of assessing the integrity of the rotator cuff although it is more costly and not as specific as arthrography.

Biceps

  • X-rays may show that your upper arm bone is out of place or that the place where the muscle attaches has changed.
  • If your biceps tendon is completely ruptured, the biceps retracts toward the elbow causing a swelling just above the crease in your arm. This is called the Popeye deformity.
  • You will experience decreased strength of elbow flexion and arm supination (moving the hand palm up).
  • You will have decreased ability to raise the arm out to the side when the hand is turned palm up.

Ruptured Tendon Treatment

Self-Care at Home

For all ruptured tendons, regardless of the site, follow the standard RICE (Rest, Ice, Compression, Elevation) home therapy procedure as you seek medical attention. RICE involves:

  • Resting the affected extremity
  • Applying ice to the affected area
    • Apply ice in a plastic bag wrapped in a towel or with a reusable cold pack wrapped in a towel.
    • Applying ice directly to skin may lead to further damage if left on for a prolonged period of time.
  • Compression of the affected area to minimize swelling
    • Apply compression by loosely wrapping the affected area with an ACE bandage.
    • Be sure that the bandage does not cut off blood flow to the area in question.
  • Elevation of the extremity if possible
    • Try to keep the area above the level of your heart to minimize swelling.
    • It is recommended that the quadriceps rupture should be immobilized in an extended (straight knee) position and that biceps rupture should be immobilized in a sling with the elbow bent at 90°.

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.
    • This treatment has been advocated by some because it gives similar results to surgery in motion and strength. The problem with this treatment is that it has a rerupture rate of up to 30%. Nevertheless, it may still be a reasonable option for those who are at increased operative risk because of age. medical problems. or inactivity.
  • Rotator cuff
    • The rotator cuff is unique because treatment without surgery is the treatment of choice in most tendon injuries. More than 90% of tendon injuries are long term in nature, and 33-90% of these chronic rupture symptoms go away without surgery.
    • In contrast, acute rupture, as occurs with trauma, may or may not be repaired surgically depending on the severity of the tear.
    • If the tear is either less than 50% of the cuff thickness or less than 1 cm in size, the dead tissue is removed arthroscopically. A small incision is made and a tool called an arthroscope is passed into the joint. Through it, the surgeon can see and remove dead tissue without actually cutting the joint open. The shoulder is then left to heal.
  • Biceps
    • Most surgeons prefer not to operate on a ruptured biceps tendon because function is not severely impaired with its rupture.
    • Studies suggest that after biceps rupture, only a small fraction of elbow flexion is lost and approximately 10-20% strength reduction in supination (ability to turn the hand palm up). This is considered to be a moderate loss and not worth the risk of surgery in middle-aged and older people.

Surgery

  • 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 noninjured leg in 6 months.
  • Achilles tendon
    • Surgery to repair your Achilles tendon is recommended for active people who desire near normal strength and power in plantarflexion. An additional advantage with surgical correction is a lower rerupture 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 weightbearing is started. Surgery carries with it a higher risk of infection than closed treatment.
  • Rotator cuff
    • Many surgeons will not attempt surgical repair until nonoperative 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.
    • Acromioplasty, removal of the coracoacromial ligament and repair of the rotator cuff tendon, usually results in near full rotator cuff strength.
  • 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.

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