Summary

A tendon rupture is a tear or complete break in a tendon, the strong fibrous tissue that connects muscle to bone. Think of tendons as strong ropes that transmit muscle force to bones—when a tendon ruptures, the muscle can't move the bone properly, causing weakness, pain, and loss of function. Tendon ruptures can occur from trauma (sudden force, direct injury), overuse (repetitive stress), or degeneration (weakened tendon from age, disease). The most common sites are the Achilles tendon (back of ankle), rotator cuff (shoulder), biceps tendon (elbow), and quadriceps/patellar tendons (knee). The severity ranges from partial tears (some fibers torn) to complete ruptures (tendon completely torn). The key to management is recognizing the rupture (sudden pain, weakness, loss of function, sometimes a "pop" sound), confirming the diagnosis (clinical examination, sometimes ultrasound or MRI), and appropriate treatment (conservative for partial tears, surgery for complete ruptures or significant functional loss). Most partial tears heal well with conservative treatment, but complete ruptures often need surgery to restore function.

Key Facts

• Definition: Tear or complete break in a tendon
• Incidence: Common (thousands of cases/year)
• Mortality: Very low (<0.1%) unless complications
• Peak age: Varies by site (Achilles = 30-50 years, rotator cuff = older)
• Critical feature: Sudden pain, weakness, loss of function
• Key investigation: Clinical examination, ultrasound or MRI
• First-line treatment: Conservative (partial tears), surgery (complete ruptures or significant functional loss)

Clinical Pearls

"Sudden onset is classic" — Tendon ruptures usually happen suddenly with a "pop" sound, immediate pain, and weakness. The patient often knows something "snapped."

"Clinical examination is usually diagnostic" — Most tendon ruptures can be diagnosed clinically (weakness, inability to perform specific movements, palpable gap). Imaging confirms but isn't always needed.

"Complete ruptures usually need surgery" — Complete ruptures, especially in active people or if significant functional loss, usually need surgery to restore function. Conservative treatment may work for some, but surgery gives better outcomes.

"Timing matters for surgery" — If surgery is needed, it's usually best done within 2-4 weeks (before the tendon retracts too far). Don't delay if surgery is indicated.

Why This Matters Clinically

Tendon ruptures are common injuries that can cause significant functional loss if not treated appropriately. Early recognition, proper diagnosis, and appropriate treatment (conservative vs surgery) are essential to restore function. This is a condition that orthopedic clinicians manage frequently, and prompt treatment leads to better outcomes.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: Usually normal
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal
• Feel: Pulse (usually normal), BP (usually normal)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR
• Action: Monitor if severe

D - Disability

• Assessment: Usually normal
• Action: Assess if severe

E - Exposure

• Look: Local examination
• Feel: Tenderness, gap, weakness
• Action: Complete examination

Specific Examination Findings

Local Examination:

• Inspection: Swelling, bruising, deformity
• Palpation:
  • Tenderness: At rupture site
  • Gap: Palpable gap (if complete rupture)
  • Swelling: Soft tissue swelling
• Function: Test specific movements
• Strength: Test strength (weakness)

Site-Specific Tests:

Special Tests

Natural History (Without Treatment)

Untreated Tendon Rupture:

• Partial tears: May heal but with weakness
• Complete ruptures: Usually don't heal, permanent weakness
• Poor outcomes: If not treated appropriately

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes
• Surgery for complete ruptures: Better outcomes
• Young age: Better healing
• Good rehabilitation: Better outcomes

Poor Prognosis:

• Delayed treatment: Worse outcomes
• Conservative for complete ruptures: Worse outcomes
• Older age: May heal slower
• Poor rehabilitation: Worse outcomes

Prognostic Factors

Key Guidelines

1. AAOS Guidelines (2010) — Management of Achilles tendon rupture. American Academy of Orthopaedic Surgeons

Key Recommendations:

• Surgery for complete ruptures (especially active people)
• Conservative for some complete ruptures
• Evidence Level: 1A

Landmark Trials

Multiple studies on surgical vs conservative treatment, outcomes.

Evidence Strength

What is a Tendon Rupture?

A tendon rupture is a tear or complete break in a tendon, the strong tissue that connects your muscle to your bone. Think of tendons as strong ropes that transmit muscle force to bones—when a tendon ruptures, the muscle can't move the bone properly, causing weakness and loss of function.

In simple terms: One of the strong tissues connecting your muscle to your bone is torn. This causes weakness and loss of function, but with proper treatment, most people recover well.

Why does it matter?

Tendon ruptures can cause significant functional loss if not treated appropriately. Early recognition and appropriate treatment (conservative for partial tears, surgery for complete ruptures) are essential to restore function. The good news? With proper treatment, most people recover well and regain function.

Think of it like this: It's like a rope breaking—the muscle can't pull the bone anymore, causing weakness. With the right treatment, the rope can be fixed and function restored.

How is it treated?

1. Assessment:

• Examination: Your doctor will examine the affected area and test your strength
• Tests: You may have an ultrasound or MRI to see the rupture
• Why: To see how serious it is and decide the best treatment

2. Treatment:

• If partial tear: You'll rest the area, use ice, and do physical therapy. Most partial tears heal with this treatment.
• If complete rupture: You'll usually need surgery to repair the tendon (usually within 2-4 weeks). Surgery gives better outcomes than conservative treatment for complete ruptures.

3. Rehabilitation:

• Physical therapy: You'll do exercises to regain strength and movement
• Gradual return: You'll gradually return to activities
• Why: To help you recover and regain function

The goal: Repair the torn tendon and help you regain full function.

What to expect

Recovery:

• Partial tears: Usually heal within 6-12 weeks with conservative treatment
• Complete ruptures (surgery): Usually recover within 3-6 months
• Complete ruptures (conservative): May take longer, may not recover fully

After Treatment:

• Immobilization: You may need to wear a splint or cast for several weeks
• Physical therapy: You'll do exercises to regain strength
• Activity: You'll gradually return to activities
• Follow-up: Regular follow-up to monitor recovery

Recovery Time:

• Partial tears: Usually 6-12 weeks
• Complete ruptures (surgery): Usually 3-6 months
• Complete ruptures (conservative): May take longer, may not recover fully

When to seek help

See your doctor if:

• You have sudden pain and weakness in a muscle/tendon
• You heard or felt a "pop" and now have weakness
• You can't perform a specific movement
• You have concerns about an injury

Call 999 (or your emergency number) immediately if:

• You have an open injury (tendon visible)
• You have severe pain and can't move
• You feel very unwell

Remember: If you have sudden pain and weakness, especially if you heard or felt a "pop", see your doctor. Tendon ruptures are common and usually treatable, but they need proper treatment to restore function. Don't delay—if it's a complete rupture, surgery is usually best done within 2-4 weeks.