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Ruptured Tendon
All ruptured
tendons, regardless of site, follow standard RICE (Rest, Ice, Compression,
Elevation) home therapy procedure as you seek medical attention.
- Resting the affected
extremity
- Ice application 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 because 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 or medical problems
or inactive people who may tolerate mild weakness in supporting weight on
the ball of your foot (called plantarflexion).
- 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 less
than 50% of the thickness of the muscle 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 long head of the biceps tendon because
function is not severely impaired with its rupture.
- Studies suggest
that after a rupture of the long head of the biceps tendon, 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.
- However, ruptures
of the major biceps tendons are typically repaired surgically. Otherwise,
flexion of the elbow and strength of the arm will be greatly impaired.
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