Tendon rupture is a severe type of tendon injury and may involve virtually any tendon in the body. Although trauma and sports-related activities are principal mechanisms of tendon rupture, preexisting degenerative changes seem to be the most important factor for this soft tissue injury. The diagnosis is primarily made through a physical examination. Imaging studies are used to support clinical findings.
Presentation
A tendon rupture is described by many reports as one of the most severe forms of tendon injury. The etiology seems to be multifactorial, as trauma and intense eccentric contractions (seen predominantly during sports activities), as well as iatrogenic causes (the use of fluoroquinolones and corticosteroids have been confirmed as risk factors for tendon rupture), seem to be equally important [1] [2] [3] [4] [5]. However, degenerative changes that have been histologically confirmed in many cases (particularly in those who suffered from Achilles tendon rupture) are considered as a prerequisite in order for tendons to rupture [1] [2] [3]. Various studies have described that virtually any tendon in the body could rupture, with respective differences in the clinical presentation [1] [2] [3] [4] [5] [6] [7] [8] [9] [10]:
- Achilles tendon rupture - The Achilles tendon, whose function is to allow plantar flexion of the ankle induced by the triceps surae muscle (two heads of the gastrocnemius and the soleus muscle) is most commonly mentioned in the literature in relation to tendon ruptures [1]. It is encountered in adults who are engaged in strenuous sports activities during their fourth and fifth decades of life and there is a significant predilection for male gender [1] [2]. A sudden onset of pain after an intense plantar flexion is the typical clinical presentation, and many patients cannot stand or bear any weight on the affected leg [2]. In addition, a "pop" sound is reported, denoting the separation of the tendon from its attachment site on the bone [2].
- Biceps rupture - Although it is not commonly encountered in clinical practice, excessive eccentric contractions of this muscle (for example, during heavy lifting) might cause rupture of its tendon, both in the proximal, and less commonly the distal part [6]. A sudden onset of pain accompanied by a tearing sensation in the antecubital region (where the rupture has occurred) is seen in virtually all cases [6]. Similar to Achilles tendon rupture, a "pop" sound is usually heard [6].
- Quadriceps and patellar tendon rupture - Tendons of the quadriceps and patella are also susceptible to rupture, most often caused by an abnormal contraction of the quadriceps muscle while the knee is in moderate flexion, during strenuous running activities (such as sprinting) or due to trauma [7] [10].
- Flexor and extensor ruptures of the fingers - As with other types of ruptures, traumatic tendon injury following excessive activity been attributed as causing the rupture of the tendons in the hand [8] [9].
Entire Body System
- Pain
We are reporting a case of apparently spontaneous iliopsoas tendon rupture that occurred in an elderly patient presenting with severe debilitating hip pain whose etiology initially was unrecognized. [ncbi.nlm.nih.gov]
- Inflammation
Many over-the-counter medications are used not only for pain relief, but also to reduce inflammation. Common over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs and aspirin will reduce inflammation. [iwalk-free.com]
Article continues below Tendonitis Once used to describe almost any tendon pain, medical professionals now only use the term tendonitis to describe acute inflammation of the tendon due to small (micro) tears (the suffix “itis” indicates inflammation). [sports-health.com]
It may be due to retrocalcaneal bursitis where inflammation occurs within the sac that cushions the tendon as it passes the bony edge of the heel bone. Paratenonitis is inflammation of the tendon sheath that surrounds the length of the tendon. [medicinenet.com]
Moreover, tendon pain, swelling, or inflammation (tendonitis) can lead to degenerative changes in the tendon, or tendinosis, which may cause a rupture—even one year after discontinuing the antibiotic. [strengthsensei.com]
Conservative treatments rely on their ability decrease pain, reduce inflammation, and facilitate healing of the ruptured ends of the tendon. [footanklespecialtygroup.com]
- Surgical Procedure
When conservative management failed, surgical reconstruction with suture reinforced with synthetic mesh was attempted. The knee was immobilized in full extension for 6 weeks after the surgical procedure. [ncbi.nlm.nih.gov]
Surgical procedure involves opening the skin and suturing the torn tendon together. Surgery helps to decrease the recurrence of the Achilles tendon in comparison to the non-surgical treatment. [orthotree.com]
Surgical Repair of Distal Biceps Tendon Ruptures. A Biomechanical Comparison of Two Techniques Distal biceps tendon repair: Comparison of surgical techniques. [wheelessonline.com]
- Ecchymosis
Physical examination revealed ecchymosis and weakness in elbow extension. A radiograph of the elbow showed a small fleck of bone proximal to the tip of the olecranon. The patient was initially stabilised. [ncbi.nlm.nih.gov]
[…] immediate and sudden onset of severe pain post injury May also report a popping or tearing sensation Swelling over the knee, and difficulty or inability to weight bear will also be reported Clinical Examination: Diffuse swelling to the anterior knee Ecchymosis [lifeinthefastlane.com]
Swelling, tenderness and possible discoloration or ecchymosis in the Achilles tendon region. Indentation above the injured tendon where the torn tendon may be present. Difficulty moving around or walking. [twinboro.com]
- Difficulty Walking
Patellar Tendon Rupture: What You Need to Know Symptoms of a patellar tendon rupture may include pain, difficulty walking, tenderness and the inability to actively straighten the leg. [hopkinsmedicine.org]
Additionally, because the function of the Achilles tendon is to enable plantarflexion (bending the foot downward), patients often have difficulty walking or standing up on their toes. [ucsfhealth.org]
Cardiovascular
- Hypotension
Side effects of rituximab include fever, rash, cytopenia and hypotension, back pain, arthralgia, and myalgia. Here, we report on 3 patients who developed moderate to severe tendonitis after the second infusion of rituximab. [ncbi.nlm.nih.gov]
Musculoskeletal
- Muscle Strain
Tear Shin Pain Shin Splints Stress Fracture Tibialis Posterior Tendinopathy Muscle Injuries Compartment Syndrome Muscle Strain Cramps DOMS - Delayed Onset Muscle Soreness Overuse Injuries Systemic Conditions Rheumatoid Arthritis Fibromyalgia Psoriatic [physioworks.com.au]
Differential Diagnosis Differential diagnosis includes: Acute achilles tendon peritendinitis Gastrocnemius tear Calf muscle strain or rupture Posterior tibialis stress syndrome Fracture Posterior tibialis tendon injuries Peroneal injuries Classification [physio-pedia.com]
- Contusion
PMT lesions are classified according to 3 levels of severity: Type 1 is contusions and strains, Type 2 is a partial tear and Type 3 is a complete tear. [ncbi.nlm.nih.gov]
- Back Pain
Side effects of rituximab include fever, rash, cytopenia and hypotension, back pain, arthralgia, and myalgia. Here, we report on 3 patients who developed moderate to severe tendonitis after the second infusion of rituximab. [ncbi.nlm.nih.gov]
Psychiatrical
- Fear
Achilles tendon rupture, the fear of every middle age man on the basketball and tennis court. Now that I am in my 40s I fall into that category. And unfortunately for me, I recently felt the dreaded "pop" while playing doubles tennis. [philly.com]
There are several reasons for this, one of them could be kinesiophobia i.e. fear of moving and fear of re-rupture. What is known ? Aetiology The aetiology of Achilles tendon ruptures is still not well-known. [aspetar.com]
Workup
A meticulous physical examination is the essential step in recognizing tendon rupture and is supported by data obtained during history taking. Information regarding prior event that led to the injury is vital in assessing the severity and extent of tissue damage, whereas recent fluoroquinolone or corticosteroid use must be excluded, given their well-established roles in the pathogenesis of tendon ruptures [4] [5]. Various probes and tests can be implemented to confirm clinical suspicion toward rupture. In the setting of Achilles tendon rupture, clinical findings include a weak strength when performing plantar flexion, a palpable and often visible defect (retraction of the tendon will produce an abnormal muscular appearance) and the absence of plantar flexion when the triceps surae muscle is mechanically compressed (known as the Thompson test) [2]. Studies have illustrated that up to 100% of ruptures are diagnosed without the need for imaging studies if the examination is conducted properly, thus illustrating the role of a good physical exam [2]. Weakness in the forearm and elbow accompanied by a lack of supination when compressing the biceps belly (the biceps squeeze test) and the inability to palpate the distal biceps tendon while the elbow is flexed and supinated (the hook test) are highly suggestive of a biceps tendon rupture [6]. Quadriceps tendon ruptures are recognized by the inability of the patients to perform active knee extension [7]. If strong clinical suspicion is raised, imaging studies may be used to confirm the diagnosis. Ultrasonography and magnetic resonance imaging (MRI) are recommended because of their ability to assess the extent of the injury [2] [6].
Treatment
Abstract Background: Volar plate fixation with locked screws has become the preferred treatment of displaced distal radius fractures that cannot be managed nonoperatively. This treatment, however, is not without complication. [ncbi.nlm.nih.gov]
Prognosis
Concomitant rotator cuff disease may have important implications in the prognosis and natural history of this shoulder condition. [ncbi.nlm.nih.gov]
Treatment and prognosis Early surgical repair may be necessary to ensure good functional outcome. [radiopaedia.org]
Ruptured Achilles Tendon Prognosis You will normally be in your CAM brace for between 6 to 12 weeks. If everything goes perfectly during your rehabilitation it takes at least 12 weeks before a return to sport is possible. [physioworks.com.au]
What is the prognosis of an Achilles tendon rupture? When proper treatment and rehabilitation are undertaken, the prognosis is excellent. The majority of athletes can return to their previous exercise or sports. [medicinenet.com]
Etiology
We are reporting a case of apparently spontaneous iliopsoas tendon rupture that occurred in an elderly patient presenting with severe debilitating hip pain whose etiology initially was unrecognized. [ncbi.nlm.nih.gov]
The requested page "/publication/achilles-tendon-rupture-review-etiology-population-anatomy-risk-factors-and-injury" could not be found. [nmrl.pitt.edu]
Epidemiology
Achilles tendon rupture with special reference to epidemiology and results of surgery. Thesis. Acta Universitas Ouluensis, D Medica 383. University of Oulu, 1996 Paavola M. Achilles tendon overuse injuries. Thesis. [ebm-guidelines.com]
Epidemiology. Accessed November 30, 2015. Medscape. Surgical intervention. Accessed November 30, 2015. *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). [moveforwardpt.com]
Some cadaveric studies suggest a watershed area approximately 2 cm to 6 cm above the Achilles’ insertion, although this has not been supported in vivo. 8 Epidemiology of Achilles tendinopathy The incidence of Achilles rupture is 7 out of 100,000 in the [lermagazine.com]
Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin, 2005; 10(2):255-266. 4. Gebauer M, Beil FT, Beckmann J, Sárváry AM, Ueblacker P, Ruecker AH, Holste J, Meenen NM. [podiatrytoday.com]
Epidemiology The true incidence of patellar tendon rupture is not known, but this injury is observed less frequently than rupture of the quadriceps tendon and usually occurs in those younger than 40 years. [emedicine.medscape.com]
Pathophysiology
Thus, the pathophysiology is not well understood. Imaging for improved speed of diagnosis is rarely considered. [ncbi.nlm.nih.gov]
Pathophysiology and pathogenesis of visceral fat obesity. Obes Res 1995;3 Suppl 2:187S-194S. 42. Magnusson SP, Hansen M, Langberg H, et al. The adaptability of tendon to loading differs in men and women. Int J Exp Pathol 2007;88(4):237-240. 43. [lermagazine.com]
Pathophysiology Unilateral traumatic ruptures of the patellar tendon tend to occur when a violent contraction of the quadriceps is resisted by the flexed knee (eg, during landing after a jump). [emedicine.medscape.com]
Prevention
For patients with secondary hyperparathyroidism receiving hemodialysis, strict systematic treatment of hyperparathyroidism is needed to prevent rupture or re-rupture of the quadriceps tendon. [ncbi.nlm.nih.gov]
After removal of the cast, physical therapy is recommended to prevent stiffness and restore lost muscle tone. [orangeorthopaedics.com]
RELATED: What it Takes to Recover From an Achilles Injury Prevention Prevention of Achilles tendon injuries can be difficult if you do not display any symptoms. [stack.com]
References
- Thomopoulos S, Parks WC, Rifkin DB, Derwin KA. Mechanisms of tendon injury and repair. J Orthop Res 2015;33(6):832-839.
- Pedowitz D, Kirwan G. Achilles tendon ruptures. Curr Rev Musculoskelet Med. 2013;6(4):285-293.
- Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87(1):187-202.
- Lewis T, Cook J. Fluoroquinolones and Tendinopathy: A Guide for Athletes and Sports Clinicians and a Systematic Review of the Literature. J Athl Train. 2014;49(3):422-427.
- Lu H, Yang H, Shen H, Ye G, Lin X-J. The clinical effect of tendon repair for tendon spontaneous rupture after corticosteroid injection in hands: A retrospective observational study. Grewal. P, ed. Medicine (Baltimore). 2016;95(41):e5145.
- Quach T, Jazayeri R, Sherman OH, Rosen JE. Distal biceps tendon injuries--current treatment options. Bull NYU Hosp Jt Dis. 2010;68(2):103-111.
- Roudet A, Boudissa M, Chaussard C, Rubens-Duval B, Saragaglia D. Acute traumatic patellar tendon rupture: Early and late results of surgical treatment of 38 cases. Orthop Traumatol Surg Res. 2015;101(3):307-311.
- Gilman L, Cage DN, Horn A, Bishop F, Klam WP, Doan AP. Tendon rupture associated with excessive smartphone gaming. JAMA Intern Med. 2015;175(6):1048-1049.
- Proubasta IR, Lamas CG, Natera L, Arriaga N. Delayed rupture of all finger flexor tendons (excluding thumb) following nonoperative treatment of Colles’ fracture: A case report and literature review. J Orthop. 2015;12(1):S65-S68.
- Ciriello V1, Gudipati S, Tosounidis T, Soucacos PN, Giannoudis PV. Clinical outcomes after repair of quadriceps tendon rupture: a systematic review. Injury. 2012;43(11):1931-1938.