What is Tendon Tear?
To understand a Tendon Tear, it is a must to know what a tendon is and what are the common areas where a Tendon Tear can occur. Tendons are fibrous tissues which attach a muscle to a bone in the human bodies.1 Thus, it can be said that a tendon acts as a connector between a muscle and a bone. The more we use our muscles and bone the more pressure a tendon is put into hence the tendons of the foot and hands are the busiest tendons of the body as these two parts of the body are constantly working during the daily routine of an individual.
The pressure applied to these tendons can go up to five times the body weight of the individual itself in some cases. This extra force that is put on the tendon during the rigors of the daily life takes its toll and sometimes the tendon tends to tear or rupture. This condition is called as Tendon Tear. Certain medical conditions can also result in Tendon Tear like gout, excessive use of steroids on a tendon making it weak, or hyperparathyroidism.
Tendon Tears are not common but can be pretty debilitating as they tend to cause severe excruciating pain and if left untreated may even render an individual permanently disabled. Tendon Tear can be treated either conservatively or through surgery depending on the type of tear. Sportsmen are more prone to Tendon Tears as they put lot of pressure on the muscles and tendons.
Where Does Tendon Tear Most Commonly Occur?
Coming to the question as to the common areas as to where a Tendon Tear can occur, there are four tendons which are more prone for Tendon Tears. These tendons are:
Quadriceps Tendon: The is a combination of four muscles which are the vastus lateralis, vastus medialis, vastus intermedius, and the rectus femoris. These muscles are present just above the patella or the kneecap and form the patellar tendon. These muscles perform the function of extending the leg at the knee and facilitate ambulation, running, and jumping activities. People involved in such activities tend to tear the patellar tendon mostly.
Achilles Tendon: This tendon is present behind the foot just above the heel.2 This tendon attaches the calf muscle to the heel bone. This is one of the most common tendon which tears especially in athletes involved in running and sprinting activities as these activities puts a lot of pressure on the tendon causing an Achilles Tendon Tear.
Rotator Cuff Tendons: These tendons are situated in the shoulders. The rotator cuff is made up of four muscles which are supraspinatus, infraspinatus, teres minor, and subscapularis muscles.3 The function of these group of muscles are to allow the hands to be raised up over the head or move the hands from side to side and also protects the shoulder from moving out of its socket. People involved in construction, sports like tennis and squash, golf, and the like tend to have a Rotator Cuff Tendon Tear.
Biceps Tendon: This is also a tendon which tends to tear or rupture quite often. The function of the biceps muscle is to allow forward movement of the hand and is quite important for smooth functioning of the hands. People involved in construction, heavy lifting, manual labor, and people playing sports like tennis, squash, golf, hockey tend to have a Biceps Tendon Tear.
What are the Causes of Tendon Tear?
Tendon Tear in the elderly is usually caused by a medical condition like gout or a thyroid disorder. In the elderly population, there is decreased blood supply to the tendons making them weak and inadvertently result in Tendon Tear.
In the younger generation Tendon Tear usually occurs due to trauma during a game or due to an accident or a motorbike crash. Increased stress placed on the tendon is also a cause for Tendon Tear. People involved with heavy lifting, manual labor tend to stretch the muscles to the limit putting excessive pressure on the tendon and ultimately a Tendon Tear occurs.
Excessive use of steroids into a tendon also makes a tendon weak and results in Tendon Tear. This is usually done for treatment of a condition in which there is inflammation of the tendon caled tendonitis. Certain classes of medications have also been known to cause Tendon Tears. These medications are Cipro and Levaquin.
It is also seen that people with blood group “O” are at risk for Tendon Tears more than the other population.
What are the Symptoms of Tendon Tear?
Some of the signs and symptoms of Tendon Tears are:
- A snap or pop at the affected area
- Severe and excruciating pain
- Immediate bruising
- Severe weakness in the affected hand or leg
- Inability to use the hand or leg smoothly can be symptom of tendon tear.
- Reduced range of motion of the affected hand or leg
- Inability bear weight on the affected leg, especially in Achilles Tendon Tear
- Visible deformity in the affected area can be symptoms of tendon tear.
How is Tendon Tear Diagnosed?
A general physical examination of the patient along with radiological studies in the form of x-rays and CT/MRI scans are good enough to identify a Tendon Tear and also the severity of it. An MRI will confirm whether the tear is complete or it is a partial Tendon Tear.
What is the Treatment for Tendon Tear?
In case of a Tendon Tear, irrespective of the area of the tendon, the standard protocol that should be followed by the patient before consulting a physician is the following:
- Adequate rest for the extremity affected and avoiding activities that may aggravate the condition
- Application of ice wrapped in a towel for 15-20 minutes two to three times a day can be effective in providing relief from pain associated with tendon tear.
- Compression of the affected area so as to decrease swelling as much as possible with an ACE bandage is important in the treatment of tendon tear.
- Elevate the affected extremity as much as possible so as to calm down swelling and facilitate healing
- Take NSAIDs like Tylenol and Advil for pain control.
Once a Tendon Tear has been diagnosed, the physician will formulate a treatment plan based on the location of the Tendon Tear. These treatments are:
Treatment for Quadriceps Tendon Tear: Incomplete tears are treated by immobilizing the leg in a cast or immobilizer for a period of about six weeks. Once the pain is calmed down and the patient is able to raise the leg without any sort of pain or discomfort for about a week then gradually the immobilizer is removed and the patient is allowed to slowly start to weight bear on the affected extremity for a few weeks before returning back to full weightbearing and returning back to normal activities. For complete tear of tendon, a corrective surgery is required for treating the Tendon Tear.
Treatment for Achilles Tendon Tear: Surgery is the best method for treatment of Achilles Tendon Tear but nonoperative methods are tried for Treatment especially in those patients who have a high surgery risk like elderly people and people with another medical condition contraindicating surgery. This is done by placing the foot in such a way that the sole of the foot is pointed downwards and the fingers of the foot pointing upwards and immobilizing the foot for at least a period of eight weeks. This treatment has shown to give as much as relief as the surgery but in retrospect it has a high rate of re-tear and the tendon may tear again.
Treatment for Rotator Cuff Tendon Tear: Again, surgery is the most preferred way to treat these types of Tendon Tears but most people prefer to be treated nonoperatively. If the tear is mild, then the physician may just recommend immobilization for a period of about six weeks and then starting with gradual strengthening exercises for about four weeks before returning the patient for normal activities but surgery is a must for acute ruptures.
Treatment for Biceps Tendon Tear: This tendon most of the times is treated nonoperatively as it does no hamper the function of the hand that much. Immobilization for a period of four to six weeks in a sling is enough for the tendon to heal along with strengthening exercises before returning to normal activities.
What is the Recovery Period for Tendon Tear?
Recovery period for tendon tear depends on the type of tear. Incomplete or partial tear of the tendon can take up to 8 weeks to completely heal. It should be noted here that Tendon Tear takes a long time to heal. In cases where surgery needs to be performed, then it may take up to four months before a patient can return to normal activities postsurgery after a Tendon Tear.