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Tendon rupture

A tendon rupture is a partial or complete tear in the fibrous connective tissue that attaches muscles to bones, disrupting the transmission of force needed for movement and often causing acute pain, swelling, and functional impairment.^[1] These injuries can occur suddenly from trauma or develop gradually due to degeneration, affecting various tendons such as the Achilles, rotator cuff, biceps, quadriceps, or patellar, and are more common in middle-aged adults engaged in sports or physical activities, with incidence increasing over recent decades.^[2]^[3] If untreated, a tendon rupture may lead to permanent weakness, reduced range of motion, or disability, highlighting the importance of prompt medical evaluation.^[4] Tendon ruptures typically result from excessive tensile force exceeding the tendon's strength, either through acute overload during eccentric muscle contractions (e.g., sudden deceleration) or chronic repetitive stress leading to degenerative changes like tendinosis.^[5] Risk factors include advanced age (due to decreased vascularity and collagen integrity), corticosteroid use (which weakens tendon structure), fluoroquinolone antibiotics, underlying conditions such as rheumatoid arthritis or hyperparathyroidism, and male gender, with incidence peaking in individuals aged 30-50 years during recreational sports.^[2]

Anatomy and physiology

Tendon structure

Tendons are composed primarily of extracellular matrix (ECM), which includes densely packed collagen fibers, with type I collagen accounting for 65-80% of the dry weight and 95% of the total collagen content, along with smaller amounts of types III and V.^[6]^[7] Embedded within this matrix are elastin fibers, proteoglycans, and glycoproteins that provide hydration and structural integrity, while cellular components such as tenocytes—elongated fibroblast-like cells—synthesize and maintain the ECM to ensure tendon homeostasis.^[8]^[9] The structure of tendons exhibits a hierarchical organization that spans multiple scales, beginning at the molecular level with tropocollagen molecules assembling into collagen fibrils, which further bundle into fibers and subfascicles.^[10] These fibers group into larger fascicles surrounded by connective tissue sheaths called endotenon, while the entire tendon is enclosed by an epitenon or, in some cases, a synovial tendon sheath that facilitates gliding and reduces friction during movement.^[11]^[12] This multi-level architecture optimizes load distribution and alignment of collagen fibers parallel to the tendon's long axis. Tendons possess remarkable biomechanical properties suited to their role in transmitting contractile forces from muscle to bone, exhibiting high tensile strength ranging from 50 to 150 MPa and viscoelastic elasticity that allows storage and release of elastic energy.^[13]^[8] These characteristics enable tendons to withstand substantial longitudinal stresses while permitting controlled deformation under load, thereby protecting muscles from excessive forces and contributing to efficient locomotion.^[14] Tendons are relatively avascular tissues, classified as bradytrophic, with blood supply derived mainly from vessels in the surrounding paratenon or synovial sheaths via diffusion, leading to poor vascularity in certain zones such as watershed areas.^[15]^[16] This hypovascularity is particularly evident in regions like the mid-portion of the Achilles tendon, where limited nutrient delivery can impair tissue maintenance and repair.^[17] With advancing age, tendons undergo changes including decreased collagen turnover due to reduced tenocyte activity and biosynthesis, alongside increased non-enzymatic cross-linking of collagen fibers, which typically becomes more pronounced after the third decade of life.^[18]^[19] These alterations result in heightened tendon stiffness and reduced adaptability, potentially elevating susceptibility to mechanical failure.^[20]

Common rupture sites

Tendon ruptures most frequently occur at sites where the tendon's structural integrity is compromised by factors such as reduced vascular supply or mechanical stress concentrations, leading to predictable patterns of failure.^[12] The Achilles tendon, located at the posterior aspect of the ankle, is one of the most common sites of rupture in the lower extremity, typically occurring 2 to 6 cm proximal to its insertion on the calcaneus due to a hypovascular watershed zone in that region.^[4] This area exhibits relative avascularity, which contributes to its vulnerability.^[4] In the upper extremity, the rotator cuff tendons at the shoulder are highly susceptible, with the supraspinatus tendon being the most commonly affected, often involving tears at its insertion on the greater tuberosity of the humerus in zones prone to mechanical compression.^[21] These ruptures frequently initiate at the deep surface of the anterior supraspinatus insertion, adjacent to the long head of the biceps tendon.^[22] The biceps tendon itself ruptures at two primary locations: the proximal long head at the superior glenoid labrum or within the bicipital groove of the humerus, and the distal tendon at its attachment to the radial tuberosity near the elbow.^[23] Proximal ruptures are more prevalent overall, while distal ones typically involve the tendon-bone junction.^[23] At the knee, both the quadriceps and patellar tendons are common rupture sites, with the quadriceps tendon failing proximal to the patella at the musculotendinous junction or tendon-bone interface, and the patellar tendon rupturing between the inferior pole of the patella and the tibial tuberosity.^[24] These knee extensor mechanism tendons are structurally vulnerable near their osseous attachments, where collagen fibers transition to bone.^[24] Less frequent rupture sites include the extensor tendons of the hand, particularly in zones over the metacarpophalangeal joints (zone 5) and proximal phalanges (zone 3), and the flexor tendons in the forearm and hand, often at the A2 pulley or within the digital sheath.^[25]^[26] Anatomical variations influence rupture susceptibility across these sites; for example, the biceps long head tendon may exhibit differences in shape, origin, or even absence, while surrounding structures like the subacromial bursa in the shoulder or retrocalcaneal bursa in the ankle can alter local biomechanics and insertion points.^[12] These variations highlight the role of collagen organization in site-specific tendon strength, as denser fiber alignments provide greater resistance to tensile forces in high-load areas.^[27]

Causes and risk factors

Traumatic causes

Traumatic causes of tendon rupture involve acute mechanical forces that exceed the tendon's capacity to withstand load, leading to partial or complete failure of tendon fibers. These injuries can occur in tendons with or without underlying degenerative changes, often during sports, accidents, or occupational activities. Direct trauma or sudden overload disrupts the collagen matrix, resulting in immediate rupture.^[26] Direct trauma accounts for a significant portion of acute tendon ruptures, particularly in the hand and upper extremities, where blunt force or sharp lacerations sever tendon fibers. For instance, flexor tendon injuries frequently result from cuts with knives or machinery in occupational settings, with work-related cases comprising approximately 25% of acute traumatic tendon injuries in the hand and wrist, most common in construction, food preparation, and transportation industries. Blunt impacts, such as falls onto an outstretched hand, can cause distal triceps tendon ruptures by compressing or avulsing the tendon from its insertion. These mechanisms highlight how external forces directly compromise tendon integrity without prior weakening.^[26]^[28]^[29] Eccentric loading represents another primary traumatic mechanism, where the muscle-tendon unit undergoes sudden lengthening under tension, often during forceful contractions against resistance. A classic example is the Achilles tendon rupture during a push-off phase in sports like basketball or tennis, where the calf muscles contract while the tendon is stretched, generating peak forces that fail the tissue. Similarly, quadriceps tendon ruptures occur from violent eccentric knee extension, such as landing from a jump or during rapid deceleration. This type of loading is prevalent in dynamic activities involving explosive movements.^[24]^[30]^[4] In sports contexts, traumatic ruptures often stem from repetitive high-impact activities that culminate in acute overload, such as jumping in volleyball or throwing in baseball, which impose cyclic stresses leading to sudden failure. These injuries are especially common among recreational athletes, including "weekend warriors" who engage in sporadic intense exercise without adequate conditioning, increasing rupture risk in tendons like the Achilles during irregular high-load sessions. Occupational trauma mirrors this in manual labor, where heavy lifting or repetitive forceful motions, as seen in construction workers, precipitate extensor or flexor tendon failures.^[31]^[4]^[26] Biomechanically, tendon ruptures occur when applied forces surpass the tissue's ultimate tensile strength, typically exceeding 6-8 times body weight in the Achilles tendon during propulsion tasks like running or jumping, approaching or reaching failure thresholds of 8-10 times body weight in vulnerable regions. The poor vascularity in the mid-substance of certain tendons, such as the Achilles 2-6 cm proximal to its insertion, exacerbates damage from these traumatic events by limiting rapid repair.^[32]^[33]^[4]

Non-traumatic causes

Non-traumatic tendon ruptures often arise from underlying degenerative processes that weaken tendon structure over time, primarily through chronic tendinopathy resulting from repetitive microtrauma. This condition involves the accumulation of small injuries that disrupt the normal healing cascade, leading to disorganized collagen fibers, increased vascularity, and matrix degradation within the tendon.^[34] Histopathological studies confirm that in the majority of spontaneous ruptures, pre-existing degenerative changes are evident, with collagen disorganization and loss of tensile strength predating the rupture event.^[35] Systemic diseases can further compromise tendon integrity by promoting inflammation, metabolic disturbances, or direct tissue damage. Rheumatoid arthritis contributes to tendon weakening through chronic synovial inflammation that erodes tendon sheaths and attachments, increasing rupture risk particularly in the hands and feet.^[24] Gout, characterized by urate crystal deposition, induces acute and chronic inflammation in periarticular tissues, which can precipitate tendon ruptures, especially in the Achilles and quadriceps tendons.^[36] Similarly, hyperparathyroidism elevates calcium levels, leading to tendon calcification and fragility, often resulting in spontaneous ruptures in patients with longstanding disease.^[37] Iatrogenic factors, particularly certain medications, pose significant risks for tendon weakening and rupture. Fluoroquinolone antibiotics, such as ciprofloxacin, are associated with tendinopathy and rupture due to their interference with collagen synthesis and induction of oxidative stress in tenocytes, with risks heightened in older adults and those on concurrent corticosteroids.^[38] Corticosteroids, whether administered systemically or via local injections, impair tendon repair by suppressing inflammation excessively, inhibiting fibroblast proliferation, and causing collagen atrophy, which can lead to spontaneous rupture even after minimal stress.^[39] Lifestyle factors exacerbate tendon vulnerability by altering biomechanical loads or impairing vascular supply. Obesity increases mechanical stress on weight-bearing tendons, such as the Achilles, promoting degenerative changes and elevating rupture incidence through elevated adipokines and chronic low-grade inflammation.^[40] Smoking compromises tendon healing by reducing blood flow, inducing hypoxia, and elevating nicotine levels that delay collagen remodeling and increase rupture risk post-injury.^[41] Genetic predispositions, particularly mutations in collagen-encoding genes, underlie heritable connective tissue disorders that predispose individuals to tendon fragility. In Ehlers-Danlos syndrome, variants in genes like COL5A1 or COL1A1 disrupt collagen fibril assembly, resulting in hyperelastic yet brittle tendons prone to rupture under normal loads.^[42] These genetic factors highlight the role of inherited extracellular matrix defects in non-traumatic tendon failures, often manifesting in multiple sites.^[43]

Signs and symptoms

Acute presentation

A tendon rupture typically presents with sudden, severe pain at the site of injury, often described as sharp and immediate, accompanied by an audible or palpable "pop" or snapping sensation as the tendon fibers tear.^[2]^[44]^[45] This acute pain is frequently followed by rapid functional loss, manifesting as sudden weakness or complete inability to actively move the affected joint, such as the inability to plantarflex the foot in an Achilles tendon rupture or to abduct the arm in a rotator cuff tear. For distal biceps ruptures, there is often weakness in elbow flexion and supination, while patellar tendon ruptures lead to inability to actively extend the knee against gravity.^[30]^[46]^[47]^[48]^[23]^[49]^[50] Swelling and bruising develop quickly due to local hemorrhage, leading to ecchymosis that may extend beyond the rupture site within hours.^[51]^[52] In many cases, a palpable gap or defect in tendon continuity can be detected by gentle palpation along the affected area, particularly in ruptures like the Achilles tendon where the gap is often evident 4-6 cm above the calcaneal insertion.^[53]^[54]^[55] Specific clinical signs may vary by rupture location; for instance, a positive Thompson test, characterized by lack of plantarflexion when the calf is squeezed, indicates an Achilles tendon rupture, while the drop arm sign, where the arm cannot be held in abduction and drops suddenly, suggests a full-thickness supraspinatus rotator cuff tear. In biceps ruptures, a visible "Popeye" bulge may appear in the upper arm due to muscle retraction, and for patellar ruptures, the patella may appear elevated (patella alta) with a palpable defect below the kneecap.^[44]^[56]^[47]^[48]^[23]^[49]^[50]

Chronic presentation

In chronic tendon ruptures, particularly partial tears or untreated cases, symptoms develop gradually rather than abruptly, often stemming from degenerative changes associated with non-traumatic causes such as repetitive microtrauma or age-related wear.^[57] This insidious onset distinguishes it from acute ruptures, with patients typically experiencing a slow progression of discomfort that interferes with daily activities over weeks to months.^[58] Insidious pain in chronic tendon ruptures is commonly described as an aching or burning sensation that arises during physical activity and intensifies over time, such as localized tenderness along the Achilles tendon during walking or a dull ache in the shoulder with overhead motions.^[59] Unlike acute events, this pain may initially improve with rest but recurs and worsens with continued use, reflecting ongoing partial fiber disruption.^[60] Weakness progresses gradually in chronic presentations, leading to a measurable loss of strength in the affected tendon, often prompting compensatory overuse of adjacent muscles to maintain function—for instance, relying on deltoid activation to compensate for rotator cuff deficiency.^[61] This adaptation can exacerbate strain on surrounding tissues, further contributing to functional decline without immediate total disability. Persistent swelling characterizes chronic inflammation in these cases, manifesting as subtle, ongoing edema around the tendon without the acute bruising seen in full ruptures, such as mild puffiness near the heel in partial Achilles involvement.^[59] This low-grade swelling often accompanies tendon thickening, indicating sustained reparative processes rather than resolution.^[58] Functional limitations in chronic tendon ruptures include reduced range of motion and joint instability, where patients may notice limitations like difficulty fully flexing the foot or recurrent shoulder subluxation during arm elevation due to impaired stabilization.^[61] These deficits accumulate progressively, hindering activities requiring precise control and potentially leading to altered gait or posture. Associated tendinopathy frequently precedes or coexists with chronic partial ruptures, featuring tendon thickening, nodularity, or irregular texture as signs of underlying degenerative changes, such as collagen disorientation in the rotator cuff or mid-substance irregularities in the Achilles.^[58] These alterations create a vulnerable substrate for incomplete tears, often detectable on palpation as firm, localized swellings.^[59]

Diagnosis

Clinical assessment

The clinical assessment of suspected tendon rupture begins with a detailed history taking to identify key features such as the onset of symptoms, which is often sudden and associated with a "pop" or snapping sensation during activity.^[4] The mechanism of injury is explored, including traumatic events like forceful contraction or direct impact, alongside any prior symptoms such as tendinopathy or chronic pain, and risk factors including age over 30, male gender, corticosteroid use, or participation in sports involving explosive movements.^[31] This history helps correlate acute presentations with potential rupture sites, such as the Achilles or quadriceps tendons.^[62] Inspection follows, focusing on visual signs of asymmetry, swelling, ecchymosis, or deformity that may indicate tendon discontinuity. For instance, in proximal biceps tendon rupture, a characteristic "Popeye" sign appears as a visible bulge in the biceps muscle due to proximal retraction of the muscle belly. Similarly, in Achilles tendon rupture, there may be a flattened arch or increased passive dorsiflexion compared to the unaffected side.^[53] These observations guide suspicion toward specific tendons while noting any compensatory postures or gait abnormalities. Palpation is essential to detect localized tenderness, a palpable gap at the rupture site, or crepitus from disrupted tendon fibers. In quadriceps tendon rupture, a defect is often felt approximately 2 cm proximal to the patella superior pole, accompanied by suprapatellar swelling.^[63] For rotator cuff tears, tenderness is commonly elicited over the greater tuberosity or subacromial space.^[62] Careful palpation along the tendon length helps localize the injury and assess for partial versus complete disruption. Specific provocative tests are performed to evaluate tendon integrity, tailored to the suspected site. The Thompson test for Achilles tendon rupture involves squeezing the calf while observing for plantarflexion; absence of movement indicates a complete tear with high sensitivity.^[64] For rotator cuff involvement, the empty can test (Jobe's test) assesses supraspinatus function by resisting downward pressure on the arm in 90° abduction and 30° forward flexion with thumbs down; weakness or pain suggests impingement or tear.^[62] In knee extensor mechanism ruptures, a modified Lachman-like maneuver or inability to lock the knee in extension tests quadriceps or patellar tendon continuity.^[24] Functional tests emphasize resisted movements to quantify strength deficits and correlate with pain elicited during signs and symptoms. Patients are asked to perform active motions against resistance, such as plantarflexion for Achilles, shoulder abduction for rotator cuff, or knee extension for quadriceps tendons; marked weakness or inability to initiate movement points to rupture.^[53] These tests also aid in differentiating complete from partial ruptures, where preserved active motion against gravity or light resistance may indicate partial injury, whereas complete tears show no active excursion despite intact sensation.^[44]

Imaging and tests

Imaging plays a crucial role in confirming suspected tendon ruptures identified through clinical assessment, providing objective visualization of tendon integrity, extent of injury, and associated soft tissue or bony involvement.^[65] Common modalities include ultrasound, magnetic resonance imaging (MRI), X-ray, and computed tomography (CT), each offering distinct advantages in diagnostic accuracy and clinical utility. Laboratory tests may supplement imaging when systemic inflammatory or infectious processes are suspected.^[66] Ultrasound serves as a cost-effective, first-line imaging tool for tendon ruptures, utilizing high-frequency transducers to enable dynamic real-time evaluation. It effectively demonstrates tendon discontinuity, fiber retraction, and surrounding hematoma or fluid collection, particularly in accessible sites like the Achilles or rotator cuff tendons. For Achilles tendon ruptures, ultrasound exhibits high diagnostic performance with sensitivity ranging from 90% to 100% and specificity up to 99%, allowing rapid bedside assessment.^[65]^[67]^[68] In rotator cuff evaluations, it achieves approximately 92% sensitivity and 94% specificity for full-thickness tears, comparable to MRI in experienced hands.^[69] Its non-invasive nature and lack of radiation make it ideal for initial screening and follow-up monitoring of healing.^[70] MRI provides superior detailed visualization of soft tissues and is considered the gold standard for assessing partial-thickness tears, tendon retraction, and associated inflammation or edema. T2-weighted sequences highlight fluid signals within ruptured tendons, delineating the tear's size, location, and involvement of adjacent structures such as muscles or bursae. For rotator cuff ruptures, standard MRI demonstrates about 92% sensitivity and 93% specificity for full-thickness tears, with enhanced performance for partial tears when using MR arthrography (up to 95% sensitivity).^[65]^[69] Though more expensive and less accessible than ultrasound, MRI is invaluable for preoperative planning in complex cases.^[66] X-ray offers limited direct assessment of tendons but is routinely used to detect indirect signs of rupture, such as avulsion fractures or soft-tissue swelling, while ruling out concomitant bony injuries. It is particularly helpful in evaluating patellar or quadriceps tendon ruptures where osseous avulsions may occur.^[71]^[72] As a quick, low-cost initial study, it complements advanced imaging but lacks sensitivity for isolated soft-tissue disruptions.^[65] CT scan is reserved for complex or equivocal cases, providing high-resolution cross-sectional images useful for surgical planning, especially in calcific tendinopathy or when bony anatomy must be precisely evaluated. In Achilles tendon ruptures, CT demonstrates high accuracy in confirming complete tears and assessing retraction, outperforming X-ray for soft-tissue detail.^[73]^[66] Its role is secondary to ultrasound and MRI due to radiation exposure and inferior soft-tissue contrast.^[65] Laboratory tests, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are employed to investigate potential systemic causes of tendon rupture, such as underlying infection or inflammatory arthropathies. Elevated levels may indicate infectious tenosynovitis mimicking or complicating rupture, guiding further management.^[74]^[75] These markers are nonspecific but provide supportive evidence when clinical suspicion for non-traumatic etiologies exists.^[76]

Treatment

Non-surgical options

Non-surgical options for tendon rupture primarily involve conservative management strategies aimed at promoting natural healing through rest, protection, and rehabilitation, particularly suitable for partial tears affecting less than 50% of the tendon's cross-section, low-demand or sedentary patients, elderly individuals with comorbidities, or those at higher surgical risk due to poor tissue quality.^[77]^[4]^[78] Immobilization forms the cornerstone of initial treatment, typically involving casting or bracing to maintain the tendon in a position that approximates the ruptured ends and minimizes stress. For example, in Achilles tendon ruptures, the foot is placed in plantar flexion using a below-knee cast or walking boot with 2-3 cm heel wedges for 6-8 weeks, starting with non-weight-bearing status and progressing to partial then full weight-bearing as tolerated to facilitate collagen alignment and reduce re-rupture risk. Modern protocols often incorporate early functional rehabilitation with accelerated weight-bearing to optimize outcomes.^[4]^[79]^[80]^[81] Following the immobilization phase, physical therapy emphasizes progressive strengthening and restoration of function, often incorporating eccentric exercises to enhance tendon loading and remodeling. Protocols typically begin with early range-of-motion activities within 2-4 weeks, advancing to supervised weight-bearing mobilization and targeted strengthening (e.g., heel-drop exercises for Achilles tendons) after 4-6 weeks, which can improve strength and prevent muscle atrophy while supporting tendon repair.^[4]^[80]^[82] Pain management in the acute phase relies on non-pharmacologic measures such as ice application, elevation, and rest, supplemented by short courses of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to alleviate swelling and discomfort, though prolonged use should be avoided due to potential interference with tendon healing processes.^[83]^[84] Adjunctive therapies, such as platelet-rich plasma (PRP) injections, are sometimes employed to augment healing by delivering growth factors to the injury site, but evidence remains mixed, with some studies showing short-term improvements in pain and dorsiflexion strength for Achilles ruptures while others report no medium- to long-term biomechanical or functional benefits.^[85]^[86] In appropriately selected cases, non-surgical approaches yield functional recovery rates of 70-80%, as seen in rotator cuff tears where about 75% of patients achieve satisfactory pain relief and shoulder function, though outcomes vary by tendon type and patient factors. For complete tears managed non-surgically, such as Achilles ruptures, re-rupture risks are approximately 8-12% with modern rehabilitation protocols, higher than surgical rates but with fewer complications; treatment decisions should consider individualized factors including activity level.^[87]^[4]^[81]

Surgical interventions

Surgical interventions for tendon ruptures aim to restore tendon continuity, function, and strength through operative techniques, particularly for complete tears in active individuals or when non-surgical options are insufficient. Primary repair involves direct end-to-end suturing of the ruptured tendon ends, typically performed within two weeks of injury to minimize retraction and facilitate approximation. For Achilles tendon ruptures, the Krackow locking suture technique is commonly employed, involving multiple interlocking loops to enhance tensile strength and secure the tendon ends.^[88] This method provides robust fixation, allowing for early postoperative rehabilitation.^[89] In cases of chronic ruptures or significant tendon retraction where primary repair is not feasible, augmentation with grafts is utilized to bridge gaps and reinforce the repair. Autografts, harvested from the patient's own tissue such as the hamstring or plantaris tendon, offer biological compatibility and lower infection risk but require an additional harvest site. Allografts, sourced from donors like Achilles tendon tissue, provide sufficient length for reconstruction without donor-site morbidity and are preferred for larger defects in neglected ruptures, yielding comparable functional outcomes to autografts.^[90] Tendon grafting is particularly indicated for massive or irreparable tears, promoting healing through integration with the native tissue.^[91] Procedures are tailored to the anatomical site of the rupture. For rotator cuff tears in the shoulder, arthroscopic repair is the standard, involving small incisions to reattach the tendon to the humeral head using suture anchors, which minimizes tissue trauma and enables outpatient recovery.^[92] In contrast, patellar tendon ruptures often necessitate open surgical repair, where the tendon is reattached to the patella with nonabsorbable sutures or anchors to restore knee extension, ideally performed soon after injury for optimal results.^[49] These site-specific approaches account for joint mechanics and surrounding structures, with imaging such as MRI occasionally guiding precise planning.^[93] Timing of surgery influences outcomes, with acute repairs within 72 hours to two weeks post-injury preferred to reduce complications like scar formation, though interventions up to three months remain viable for certain tendons like the rotator cuff. Delayed repairs beyond six weeks for Achilles ruptures are associated with higher rerupture risks due to tendon shortening.^[94]^[95] Anesthesia typically involves regional blocks, such as popliteal sciatic nerve blocks for lower extremity procedures, providing effective analgesia and allowing for ambulatory surgery. Postoperative protocols emphasize early mobilization, with functional bracing or controlled weight-bearing initiated within days to weeks, promoting tendon healing while preventing stiffness.^[96]^[79] Surgical repairs demonstrate high success rates, particularly in young, active patients, with rerupture rates of 2-4% compared to higher non-operative risks with traditional protocols, and over 90% achieving good to excellent functional recovery in select cohorts. For patellar tendon repairs, early intervention yields excellent short-term outcomes in over 90% of cases. Recent evidence supports shared decision-making for Achilles ruptures, as modern non-surgical approaches with advanced rehabilitation yield comparable long-term results to surgery in many cases.^[97]^[98]^[81]

Complications and prognosis

Potential complications

Tendon rupture treatment carries several potential complications, which can vary depending on the tendon affected, the chosen management approach (surgical versus non-surgical), and patient factors. Rerupture represents a significant risk, occurring in approximately 5-10% of cases overall, with rates higher in non-surgical management (up to 10.6%) compared to surgical repair (around 3.1%). This risk arises from inadequate healing or excessive stress on the repaired or immobilized tendon during recovery. Surgical interventions introduce the possibility of infection at the surgical site, with deep wound infection rates typically ranging from 1-2%, though superficial infections may be more common. These infections can delay healing and necessitate additional interventions, stemming from bacterial contamination during the procedure or poor wound care postoperatively.^[99] Adhesions, formed by excessive scar tissue, are a frequent issue following both surgical repair and immobilization, leading to joint stiffness and reduced range of motion. Incidence varies by tendon location—for instance, up to 10% in hand flexor tendon repairs and around 5.6% in minimally invasive Achilles repairs—but adhesions generally result from the body's inflammatory response to injury, limiting tendon gliding and requiring potential adhesiolysis for resolution.^[100]^[101] Iatrogenic nerve or vessel damage can occur during surgical dissection, particularly in anatomically complex areas like the Achilles or rotator cuff regions, with sural nerve injury reported in up to 13% of early percutaneous Achilles repairs. Such damage may cause sensory deficits, numbness, or vascular compromise, often due to direct trauma from instruments or sutures.^[102] Chronic pain syndromes, including complex regional pain syndrome (CRPS), may develop post-injury or after prolonged immobilization, characterized by disproportionate pain, swelling, and autonomic changes. While rare, CRPS has been linked to tendon ruptures as a precipitating trauma, with risk factors including nerve injury and female sex, potentially arising from neuroinflammatory responses.^[103] Deep vein thrombosis (DVT) is a concern primarily from extended immobilization in casting or bracing, with incidence rates reported between 0.3% and 50% in acute Achilles tendon rupture cases, often approaching 50% without prophylaxis due to venous stasis in the lower limb.^[104]

Recovery and outcomes

Recovery from tendon rupture typically involves an initial phase of immobilization followed by structured rehabilitation to restore function. For many tendon ruptures, such as those in the Achilles or biceps, immobilization in a cast, splint, or boot lasts 4-6 weeks to protect the repair site and allow initial healing.^[31]^[105] Physical therapy then commences, focusing on range of motion, strengthening, and proprioception, often spanning 3-6 months. Full return to pre-injury activities generally occurs between 6-12 months, though complete restoration of strength and endurance may extend to 18-24 months in demanding cases like athletic pursuits.^[31]^[106] Several factors influence recovery outcomes, including patient age, the specific tendon affected, and the chosen treatment modality. Younger patients and athletes tend to benefit more from surgical intervention, which can yield superior strength recovery and lower re-rupture rates compared to conservative management.^[106] Rupture site plays a role; for instance, lower extremity tendons like the Achilles may experience more elongation and gait alterations than upper extremity ones such as the biceps.^[106] Adherence to rehabilitation protocols is crucial, as delays or inconsistencies can prolong deficits.^[105] Functional recovery metrics highlight that most patients achieve 80-90% of pre-injury strength and endurance, particularly with timely intervention.^[106] Heel-rise or dynamometry tests for lower limb ruptures often reveal persistent but manageable deficits of 10-20% in calf or plantarflexion power.^[106] In upper limb cases, such as rotator cuff repairs, shoulder abduction and external rotation typically return to near-normal levels within a year.^[107] Quality of life impacts are generally positive, with the majority resuming daily activities and work without major limitations. However, in about 20% of chronic rupture cases, persistent weakness or reduced endurance can affect mobility or sports participation, leading to ongoing adaptations.^[108] Patient-reported scores, like the Achilles Tendon Total Rupture Score, often improve significantly by 12 months, reflecting better symptom control and function.^[106] Follow-up care includes serial assessments at 3, 6, and 12 months post-treatment, incorporating strength testing via dynamometry or functional tests and imaging such as ultrasound to monitor healing and detect elongation or re-tear.^[106]^[109] These evaluations help adjust rehabilitation and ensure optimal long-term prognosis.^[105]

Epidemiology and prevention

Incidence and demographics

Tendon ruptures occur at an overall incidence of approximately 29 cases (95% CI: 20–44) per 100,000 person-years in general populations, with variations depending on the specific tendon and region.^[110] This rate is often higher among males, with ratios ranging from 2:1 to 4:1 depending on the tendon type and activity level, attributed to greater participation in high-impact activities and biomechanical differences.^[111]^[112] The age distribution of tendon ruptures exhibits a bimodal pattern, with peaks in the 30- to 40-year age group—often linked to sports-related trauma—and another in individuals over 60 years, associated with degenerative changes.^[111] Among older adults, rotator cuff tears affect 20% to 30% of those aged 60 and above, reflecting age-related tendon weakening and cumulative wear.^[113] Achilles tendon ruptures account for roughly 50% of spontaneous cases across all tendon injuries, underscoring their prominence in non-traumatic presentations.^[4] Geographic variations highlight higher incidences in physically active populations; for instance, Achilles tendon ruptures reach up to 41.7 per 100,000 person-years in Scandinavia, such as Sweden, compared to lower rates in less active regions.^[114] Incidence trends indicate a steady increase driven by aging populations and rising sports participation, with U.S. rates for all tendon ruptures rising significantly from 2001 to 2020 (annual percent change of 3.0%).^[115] Recent data as of 2024-2025 show continued increases in sports-related tendon rupture incidence in the U.S., with male rates 7.7 times higher than females.^[112]

Preventive measures

Preventive measures for tendon rupture focus on modifiable risk factors through structured training, pharmacological caution, protective aids, early detection, nutritional strategies, and workplace adjustments, particularly benefiting high-incidence groups such as middle-aged male recreational athletes.^[116] These approaches aim to enhance tendon resilience, reduce overload, and address underlying vulnerabilities without invasive interventions. Training protocols are central to prevention, emphasizing gradual progression to allow tendons to adapt to mechanical stress and minimize acute or overuse injuries. Starting new activities slowly and increasing intensity incrementally has been shown to lower rupture risk by promoting tendon remodeling.^[117] Eccentric strengthening exercises, which involve controlled lengthening under load, are particularly effective for tendons like the Achilles. The Alfredson protocol, involving 180 daily heel-drop repetitions over 12 weeks with both straight and bent knees, improves tendon stiffness and reduces tendinopathy progression, as evidenced by long-term follow-up studies.^[118] Similar protocols can be adapted for other tendons, such as the rotator cuff, to build capacity in high-demand sports or occupations. Managing modifiable risk factors involves targeted medical and lifestyle changes. Fluoroquinolone antibiotics should be avoided in high-risk patients, including those over 60, on corticosteroids, or with tendon disorders, due to a substantially elevated rupture risk—up to 46-fold when combined with steroids—prompting FDA restrictions to alternative therapies when possible.^[119]^[120] Smoking cessation is equally critical, as nicotine impairs tendon vascularity, collagen synthesis, and healing, with smokers exhibiting larger rotator cuff tears and delayed recovery; quitting enhances tissue perfusion and reduces chronic degeneration.^[121]^[122] Protective equipment plays a key role in altering biomechanics and absorbing impact during activities. Custom orthotics, such as arch-support insoles, redistribute forces to decrease Achilles tendon loading by up to 20% during running, with randomized trials demonstrating reduced pain and improved function in tendinopathy-prone individuals.^[123]^[124] In sports, padding or braces for elbows and knees mitigate direct trauma and repetitive strain, while heel lifts or supportive footwear prevent excessive elongation in high-impact scenarios. Screening tools enable proactive intervention for at-risk populations. Ultrasound imaging identifies structural abnormalities like hypoechogenicity or neovascularization in asymptomatic tendons, predicting time-loss injuries with relative risks up to 17-fold for the Achilles in collegiate athletes; pre-season scans are recommended for those on long-term steroids or with family history.^[125]^[126] This non-invasive modality supports tailored monitoring without radiation exposure. Emerging nutritional support targets tendon matrix integrity. Collagen peptide supplementation, especially 15 g daily combined with vitamin C, boosts collagen synthesis by up to 100% post-exercise, as shown in dose-response studies on resistance-trained individuals, potentially fortifying tendons against rupture.^[127] Recent 2024-2025 trials confirm that 30 g hydrolyzed collagen with 50 mg vitamin C, timed before loading activities, enhances patellar tendon properties (e.g., increased cross-sectional area, stiffness, and Young's modulus) in middle-aged men during resistance training, with potential implications for injury prevention, though direct long-term rupture risk reduction data remains under investigation.^[128] Occupational guidelines emphasize ergonomics to curb overuse in repetitive tasks. Implementing workstation adjustments, such as neutral postures, micro-breaks every 20-30 minutes, and tool modifications to minimize force, reduces musculoskeletal disorder incidence by addressing awkward positions and prolonged loading, per OSHA standards.^[129]^[130] Regular assessments in industries like assembly or healthcare prevent cumulative tendon strain through rotation and training.

References

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Tendon rupture: What causes a tear and what to do about it?
May 9, 2024 · A tendon rupture is a break in a tendon, the structure that joins a muscle to a bone. It can result from overuse, an injury, or an underlying condition.Missing: definition | Show results with:definition
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Ruptured Tendon: Symptoms, Causes, and Treatments - WebMD
Nov 30, 2024 · A tendon rupture can be a serious problem and may result in excruciating pain and permanent disability if untreated.
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Achilles Tendon Rupture - StatPearls - NCBI Bookshelf
Aug 17, 2023 · Patients may describe a sensation similar to being kicked in the lower leg. Achilles tendon rupture causes significant pain and disability.Missing: reliable | Show results with:reliable
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Mechanisms of tendon injury and repair - PubMed - NIH
A wide range of injury mechanisms exist leading to tendinopathy or tendon rupture. Tears can occur in healthy tendons that are acutely overloaded (e.g., during ...
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Structure of the tendon connective tissue - PubMed
Tendons consist of collagen (mostly type I collagen) and elastin embedded in a proteoglycan-water matrix with collagen accounting for 65-80%.
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Tendon's ultrastructure - PMC - NIH
Among collagens, the most abundant component is collagen type I (95%), while type III and type V collagens represent the remaining 5% of the total collagens16.
[7]
Tendon biomechanics and mechanobiology - a mini-review of basic ...
Tenocytes produce extracellular matrix (ECM), such as collagen, fibronectin, and proteoglycans, to maintain tendon homeostasis and repair injured tendons.
[8]
The Basic Science of Tendinopathy - PMC - NIH
The ECM is composed of three major classes of biomolecules: structural proteins (collagen and elastin), specialized proteins (eg. fibrillin and fibronectin), ...Histopathological Changes · Extracellular Matrix (ecm) · Metalloproteinases And Their...
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Structure-function relationships in tendons: a review - PMC
The purpose of the current review is to highlight the structure-function relationship of tendons and related structures to provide an overview for readers.
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Hierarchical ultrastructure: An overview of what is known about ...
Tendons have a hierarchical organization (Fig. 1). A connective tissue sheath called the epitenon encloses the periphery of the tendon. The subunits of the ...
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Anatomy, Tendons - StatPearls - NCBI Bookshelf - NIH
May 1, 2024 · The paratenonium (paratenon) is composed of type I and type III collagen fibrils and thin elastic fibers. This structure reduces friction ...
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May 22, 2017 · Ultimate tensile strengths for tendons and ligaments range from 50 to 150 MPa (for comparison, recall that the tensile strength of bone is about ...
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Tendon Stress - an overview | ScienceDirect Topics
Tendons are elastic structures connecting muscles to bones. Their primary function is to transmit loads generated in the muscles and to actuate the bone they ...
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Tendon Vasculature in Health and Disease - PMC - NIH
Tendons represent a bradytrophic tissue which is poorly vascularized and, compared to bone or skin, heal poorly. Usually, a vascularized connective scar ...
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The vasculature and its role in the damaged and healing tendon
Tendon is a comparatively poorly vascularised tissue that relies heavily upon synovial fluid diffusion to provide nutrition.
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Achilles Tendinopathy - StatPearls - NCBI Bookshelf - NIH
Aug 17, 2023 · ... blood supply to the tendon.[4]. Studies have identified a hypovascular area susceptible to injury, located approximately 2 to 6 cm proximal ...Missing: vascularity | Show results with:vascularity
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Effect of Aging on Tendon Biology, Biomechanics and Implications ...
Oct 14, 2023 · As aging progresses, collagen biosynthesis can be reduced by multiple processes including depletion of collagen-secreting tenocytes and its ...
[18]
Effect of aging and exercise on the tendon
Tendon fibril diameter, collagen content, and whole tendon size appear to be largely unchanged with aging, while glycation-derived cross-links increase ...
[19]
Age-related changes in the physical properties, cross-linking ... - PMC
The current scientific consensus is that collagen cross-linking increases with age and that this increase leads to tendon stiffening. Here, we show that this ...
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Anatomy, Rotator Cuff - StatPearls - NCBI Bookshelf
Most often, the tears initially begin as partial tears of the supraspinatus tendon. Eventually, they can progress to full-thickness tears including all four of ...
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The biomechanics of the rotator cuff in health and disease - NIH
3.5. Rotator cuff tears typically start at the deep surface of the anterior insertion of supraspinatus, adjacent to the long head of biceps (LHB) tendon, as ...3. Biomechanics · 3.2. Force Couples &... · 3.3. Joint Reaction Forces
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Biceps Tendon Rupture - StatPearls - NCBI Bookshelf
Rupture of the proximal biceps tendon can be treated conservatively, while injury to its distal attachment usually needs surgical intervention.
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Quadriceps Tendon Rupture - StatPearls - NCBI Bookshelf
Quadriceps tendon ruptures are due to violent eccentric loading of the knee extensor mechanism as a direct result of a sudden and strong contraction of the ...
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Hand Extensor Tendon Lacerations - StatPearls - NCBI Bookshelf
Oct 5, 2024 · Extensor tendon lacerations of the hand are common injuries that can lead to significant functional impairment if not properly managed.
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Mechanisms of tendon injury and repair - PMC - NIH
This review will describe the current state of knowledge of injury and repair of the three most common tendinopathies-- flexor tendon lacerations, Achilles ...
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Tendon injuries: Basic science and new repair proposals - PMC - NIH
Jul 27, 2017 · These are the rotator cuff, forearm extensors, Achilles tendon, tibialis posterior and patellar tendons. The attachment of tendon to bone is ...Tendons Basic Biology · Architecture And Molecular... · Table 2
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The Incidence of Acute Traumatic Tendon Injuries in the Hand and Wrist: A 10-Year Population-based Study - PMC
### Definition
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Distal Triceps Tendon Ruptures: A Case Series Highlighting ...
Apr 10, 2025 · ... tendon ruptures through various mechanisms, including direct trauma and heavy lifting. Clinical presentations ranged from elbow swelling and ...
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Achilles tendon rupture - Symptoms and causes - Mayo Clinic
Aug 25, 2022 · An Achilles tendon rupture is an injury that is usually painful and likely to affect your ability to walk. Surgical repair is sometimes ...Overview · Symptoms · Risk FactorsMissing: reliable | Show results with:reliable<|control11|><|separator|>
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Achilles Tendon Rupture (Tear) - OrthoInfo - AAOS
Achilles tendon tears often occur from an injury to the tendon. The tears can be treated without surgery at times; however, a surgeon may recommend surgery to ...<|control11|><|separator|>
[31]
Achilles Tendon Rupture: Risk Assessment for Aerial and Ground ...
Biomechanical force analysis and implanted electrodes demonstrate tendon loads of 600% to 800% of body weight during running, close to the ultimate strength of ...Missing: threshold | Show results with:threshold
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Video analysis of Achilles tendon rupture in male professional ...
Sep 22, 2022 · Although the AT is the largest and strongest tendon in the human body, explosive propulsion tasks are thought to result in forces of around 6–8 ...
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Tendinosis - StatPearls - NCBI Bookshelf - NIH
Mar 28, 2025 · Tendinosis refers to a degenerative process within a tendon without histologic changes. Tendinopathy is a failure of the healing cascade.
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Histopathological findings in chronic tendon disorders - PubMed
Tissue degeneration is a common finding in many sports-related tendon complaints. In the great majority of spontaneous tendon ruptures, chronic degenerative ...
[35]
[Parathyroid dysfunction and rheumatic manifestations] - PubMed
Other manifestations of hyperparathyroidism include myopathy, tendon ruptures and unspecific symptoms of the muscles and skeleton. Gout as well as pseudogout ...Missing: conditions rheumatoid<|control11|><|separator|>
[36]
Simultaneous chronic rupture of quadriceps tendon and contra ...
Several systemic diseases predispose patients to spontaneous tendon rupture such as chronic renal failure in dialytic treatment, hyperparathyroidism, diabetes, ...
[37]
The Risk of Fluoroquinolone-induced Tendinopathy and Tendon ...
Possible mechanical causes include poor gastrocnemius-soleus flexibility, low-flexibility shoes, muscle fatigue resulting in tendon elongation, and micro- ...
[38]
Tendon Ruptures Associated With Corticosteroid Therapy - PMC - NIH
In five patients, tendon ruptures occurred in association with corticosteroid therapy, either systemic or local infiltration.
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Obesity Increases the Risk of Tendinopathy, Tendon Tear and ...
Obesity is associated with a higher risk of tendinopathy, tendon tear and rupture, and complications after tendon surgery than non-obesity. However, the high ...
[40]
Nicotine Dependence and Rates of Postoperative Complications in ...
Oct 30, 2023 · Smoking remains a well-characterized modifiable risk factor that has deleterious effects on tendon rupture rates and healing.
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Ehlers-Danlos syndrome: MedlinePlus Genetics
Jul 29, 2022 · Variants (also known as mutations) in at least 20 genes have been found to cause the Ehlers-Danlos syndromes. Variants in the COL5A1 or ...<|control11|><|separator|>
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Genetic Factors in Tendon Injury: A Systematic Review of the ...
Aug 23, 2017 · In addition, several specific genetic mutations have been linked to tendon injury. ... Clinical and genetic aspects of Ehlers-Danlos syndrome ...
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Achilles Tendon Injuries Clinical Presentation - Medscape Reference
Sep 4, 2025 · Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain.History · Physical Examination · Paratenonitis
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Tendon Tears Symptoms & Risk Factors - Summa Health
Typical symptoms of tendon tears include: A snap or pop at the affected area; Severe and excruciating pain; Immediate bruising; Pain and discomfort that ...
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Achilles Tendon Rupture: What Is It, Symptoms & Treatment
An Achilles tendon rupture is a full or partial tear of the Achilles tendon. This acute (sudden) injury occurs when the tendon stretches to its breaking point.Missing: reliable sources
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Rotator Cuff Tears - Shoulder & Elbow - Orthobullets
Apr 28, 2025 · Supraspinatus. Weakness to resisted elevation in Jobe position. Drop arm test. Pain with Jobe test ; Infraspinatus. ER weakness at 0° abduction.Rotator Cuff Arthropathy · Subacromial Impingement · Subcoracoid Impingement
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Tendon Ruptures - Trauma Injury - HSS
Another common, immediate sign of a tendon rupture is rapid bruising at the site of injury. These signs are usually followed by an inability to bear weight (on ...
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Achilles Tendon Rupture - Massachusetts General Hospital
The rupture of the tendon can be extremely painful. The injury is associated with a fair amount of swelling and later, discoloration. Immediately following the ...Achilles Tendon Rupture · Explore Achilles Tendon... · TreatmentMissing: symptoms | Show results with:symptoms<|control11|><|separator|>
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Achilles Tendon Rupture - Foot & Ankle - Orthobullets
Oct 10, 2025 · Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated ...
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BOFAS > Hyperbook > Trauma > Achilles Tendon Acute Rupture
palpable gap. The combination of all three signs confirms the injury in most cases. Figure 1: Left acute Achilles tendon rupture - note visible gap with loss ...
[51]
Achilles Tendon Ruptures - Austin Foot and Ankle Specialists
Recognition of a rupture can be identified by a visible or palpable gap that may be felt along the Achilles tendon approximately 4-6cm above the top back border ...<|control11|><|separator|>
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Rotator Cuff Tear: Causes, Symptoms, Treatments - HSS
Sep 29, 2024 · The most commonly torn structure in the rotator cuff is the supraspinatus tendon. But tears can occur in the infraspinatus, subscapularis or ...What is the rotator cuff? · What is a rotator cuff tear? · What are the risk factors for a...
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Rotator cuff problems: MedlinePlus Medical Encyclopedia
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Partial Achilles Tendon Rupture—A Neglected Entity - NIH
Oct 21, 2020 · Typically, there is sudden sharp pain on the medial side of the Achilles, not seldom in the proximal or midportion Achilles tendon region ( ...
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Rotator Cuff Tears - OrthoInfo - AAOS
Symptoms · Pain at rest and at night, especially if you are lying on the affected shoulder · Pain when lifting and lowering your arm or with specific movements ...Arthroscopic Rotator Cuff Repair · Surgical Treatment Options · Shoulder exercises
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Rotator Cuff Injury Clinical Presentation: History, Physical Examination
Jun 13, 2024 · Dropping of the arm in either position usually indicates a significant supraspinatus muscle tear. More subtle weakness may represent early ...
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Quadriceps Tendon Rupture - Knee & Sports - Orthobullets
Jun 4, 2025 · Diagnosis is made clinically with a palpable defect 2 cm proximal to the superior pole of the patella with inability to perform a straight ...
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Thompson Test for Achilles Tendon Rupture - Cleveland Clinic
Oct 24, 2023 · What is the Thompson test? The Thompson test is a physical test healthcare providers use to diagnose an Achilles tendon rupture (tear).
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Tendon and ligament imaging - PMC - PubMed Central - NIH
MRI and ultrasound are powerful tools for the assessment of tendons and ligaments. The imaging appearances are related to the structure of the normal tendon.
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Tendinopathy: Is Imaging Telling Us the Entire Story? - jospt
Oct 31, 2015 · Radiographs and computed tomography scanning have been used to image tendons,,; however, ultrasound and MRI are the preferred imaging modalities ...
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Sonography of Common Tendon Injuries | AJR
CONCLUSION. Sonography is important in musculoskeletal imaging, and its accuracy is at least equivalent to that of MRI for imaging tendon abnormalities.
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The Role of Ultrasound Investigation in Acute Achilles Tendon Rupture
Apr 8, 2024 · In another study, ultrasound was reported to have 94.8% sensitivity and 98.7% specificity for detecting complete Achilles tendon ruptures in ...
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Accuracy of MRI, MR Arthrography, and Ultrasound in the Diagnosis ...
MR arthrography is the most sensitive and specific technique for diagnosing both full- and partial-thickness rotator cuff tears.
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US of Acute Tendon Tears | RadioGraphics - RSNA Journals
Nov 29, 2024 · US is an effective tool for appraising acute tendon injury, allowing rapid bedside evaluation of symptoms and paving the way for prompt diagnosis and treatment ...
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CT Scan Versus MRI Versus X-Ray: What Type of Imaging Do I Need?
However, even if your doctor suspects a soft tissue injury like a tendon tear, an X-ray might be ordered to rule out a fracture. What injuries require an MRI?
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Diagnostic Imaging of an Achilles Tendon Rupture - jospt
Nov 1, 2011 · The physical therapist requested radiographs, which can be helpful in diagnosing an Achilles tendon rupture 1 and assessing bony abnormalities.<|control11|><|separator|>
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Application of Computed Tomography Processed by Picture ...
Our study indicated that CT has the highest accuracy in diagnosis of acute Achilles tendon complete rupture.
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Tenosynovitis Workup - Medscape Reference
Aug 21, 2024 · The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level are nonspecific inflammatory markers that may be obtained ...<|separator|>
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Tests for Musculoskeletal Disorders - Bone, Joint, and Muscle ...
The ESR and the CRP are usually increased when inflammation is present. However, because inflammation occurs in so many conditions, both the ESR and the CRP ...
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Inflammatory Markers | Choose the Right Test - ARUP Consult
Jun 16, 2025 · CRP is recommended over ESR to detect acute phase inflammation in patients with undiagnosed conditions, as CRP is more sensitive and specific ...Inflammatory Markers · Laboratory Testing · C-Reactive ProteinMissing: tendon | Show results with:tendon
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Progression of partial to complete ruptures of the Achilles tendon ...
Mar 12, 2024 · Conservative management is considered acceptable in partial tendon ruptures affecting less than 50% of the tendon's width, but supporting ...
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Surveying the management of Achilles tendon ruptures in the ... - NIH
There was consensus that non-surgical treatment is preferred for sedentary and systemically diseased patients and surgery for patients who are younger and ...
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The ruptured Achilles tendon: operative and non-operative treatment ...
Treatment options include operative repair with postoperative immobilization, operative repair with accelerated rehabilitation using early weight bearing, as ...
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Evidence-based treatment of Achilles tendon rupture - PMC - NIH
Jul 4, 2023 · Patients treated nonoperatively show an increased rate of re-rupture only if functional rehabilitation employing early range-of-motion protocols ...
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WHY ARE ECCENTRIC EXERCISES EFFECTIVE FOR ACHILLES ...
Exercises that load the tendon are promoted as being beneficial for tendinopathy with isolated eccentric exercises receiving the most attention.Missing: examples | Show results with:examples
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Treatment of Tendinopathy: What Works, What Does Not, and ... - NIH
We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, ...
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Anti-inflammatory management for tendon injuries - friends or foes?
Most physicians prescribe anti-inflammatory managements to relieve the worst symptoms of swelling and pain, including non-steroidal anti-inflammatory drugs, ...
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Effectiveness of platelet-rich plasma injections for the treatment of ...
PRP injections for the treatment of acute Achilles tendon rupture significantly improved ankle dorsiflexion angle, dorsal extension strength of the ankle, and ...
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Platelet-rich plasma injection for acute Achilles tendon rupture
Nov 1, 2022 · The evidence from this study indicates that PRP offers no patient benefit in the longer term for patients with acute Achilles tendon rupture.
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Non-Operative Management of Rotator Cuff Tears - PubMed Central
Jul 21, 2016 · Most studies show an overall success rate of around 75% for nonoperative treatment. However, the majority of studies also present a ...Missing: indications | Show results with:indications
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Surgical tip: Repair of acute Achilles rupture with Krackow suture ...
We describe a mini-open approach of Achilles tendon repair with the Krackow locking suture. By means of release of the medial edge of the investing fascia.
[84]
Management of Acute Achilles Tendon Rupture Using the Krackow ...
Krackow and tendon-bundle techniques can improve the strength of the suture used for the Achilles tendon repair and ensure good matching for broken ends, and ...
[85]
Allograft and Autologous Reconstruction Techniques for Neglected ...
Feb 1, 2023 · The reconstruction with an Achilles tendon allograft can be considered a proper treatment option, as it does not show a higher rate of complications than ...
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Surgical Interventions for Rotator Cuff Tears - NIH
Dec 12, 2024 · Technique: Tendon grafting repair is a surgical intervention used for managing significant rotator cuff tears, particularly when the remaining ...
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Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo - AAOS
Surgery to repair a torn rotator cuff most often involves re-attaching (stitching) the tendon back to its original site on the head of the humerus (upper arm ...Rotator Cuff Tears · Biceps tendon tears · Shoulder Arthroscopy
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Patellar Tendon Tear - OrthoInfo - AAOS
Symptoms · An indentation at the bottom of your kneecap where the patellar tendon tore · Bruising · Tenderness · Cramping · Your kneecap moving up into the thigh ...
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Rotator cuff injury - Diagnosis and treatment - Mayo Clinic
May 22, 2025 · Arthroscopic tendon repair. In this procedure, surgeons insert a tiny camera, called an arthroscope, and tools through small incisions. · Open ...
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Time to Surgery is an Important Factor for Acute Achilles Tendon ...
Dec 26, 2023 · Patients with an acute Achilles tendon rupture surgically treated within 6 weeks from injury and a minimum follow up of 3 months ± 14 days were ...
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Acute tears of the rotator cuff. The timing of surgical repair - PubMed
Thirty-seven patients had surgical repair within three months after significant ruptures of the shoulder rotator cuff. Twelve were repaired within three ...<|separator|>
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Popliteal sciatic nerve block versus intrathecal anesthesia for ... - NIH
Jul 21, 2025 · Currently, intrathecal anesthesia is predominantly utilized in clinical practice for Achilles tendon repair surgery (4). However, some studies ...Missing: care | Show results with:care
[93]
Achilles Tendon Ruptures: Nonsurgical Versus Surgical Treatment
Nonsurgical management and early weightbearing protocols have demonstrated comparable functional outcomes compared to surgery in selected patients. The UKSTAR ...
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Acute Patellar Tendon Ruptures: An Update on Management
Outcomes of partial patellar tendon repair are limited; however, in the Karlsson series, short-term results were excellent or good in 25 (92.5%) of surgical ...
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Incidence of postoperative wound infections after open tendo ...
Surgery for TA ruptures is associated with general skin healing complication rates of about 8.2%–14.6% and deep wound infection rates of 1%–2%.
[96]
Risk factors associated with tendon adhesions after hand ... - NIH
Apr 18, 2023 · The rate of tendon adhesions after tendon injury repair is as high as 10%, with severe disability as a result, while the exact cause is unknown ...
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The release of adhesions improves outcome following minimally ...
Oct 18, 2021 · The incidence of patient-reported adhesions following minimally invasive repair of Achilles tendon rupture was estimated to be 5.6%.
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Management of acute Achilles tendon ruptures: A review - PMC
The treatments of acute Achilles tendon rupture include operative and nonoperative treatments. Operative treatments mainly consist of open repair, percutaneous ...
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[PDF] Risk factors for complex regional pain syndrome in patients with ...
We found that motor nerve injury and being female were important risk factors for CRPS. Traumatic tendon rupture, fracture, sensory nerve in- jury, and the side ...
[100]
Risk of Deep Vein Thrombosis After Acute Achilles Tendon Rupture
Apr 28, 2020 · The incidence of deep vein thrombosis (DVT) in the treatment of acute Achilles tendon rupture is reported to be between 0.3% and 50%.
[101]
Achilles tendon rupture - Diagnosis and treatment - Mayo Clinic
Aug 25, 2022 · Complications can include infection and nerve damage. ... People with an Achilles tendon rupture commonly seek immediate treatment at a hospital's ...
[102]
Outcome evaluation after Achilles tendon ruptures. A review of ... - NIH
This article describes the most commonly reported outcome measures used to assess patients treated for ATR.Objective Measures · Calf Muscle Size · Multi-Item Scoring Scales
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Long-Term Outcomes of Massive Rotator Cuff Tear Repair - NIH
The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long- ...
[104]
Persistent Deficits after an Achilles Tendon Rupture - NIH
Persistent muscle weakness, tendon elongation, and incomplete return to preinjury level are frequent sequelae after acute Achilles tendon rupture.
[105]
Ultrasonographic Evaluation of the Early Healing Process After ... - NIH
Aug 13, 2018 · Purpose: To examine changes in repaired Achilles tendon healing with ultrasonography for up to 12 months after surgery. Study Design: Case ...
[106]
Worldwide Incidence and Surgical Costs of Tendon Injuries
The total number of tendon ruptures in the world ranges from 80 to 90 cases per 100,000 inhabitants, i.e., 6 to 7 million per year. There is a linear ...
[107]
Epidemiology of Achilles Tendon Ruptures in the United States
Nov 26, 2018 · While AT ruptures in the US most commonly occur in young male patients (20-39 years old), the largest rise in the incidence was observed in ...
[108]
Age-related prevalence of rotator cuff tears in asymptomatic shoulders
In group 1 (aged 50 to 59 years), 13% (22 of 167) of the patients had tears; in group 2 (aged 60 to 69 years), 20% (22 of 108) of the patients had tears; in ...
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Global Trends in the Incidence of Achilles Tendon Rupture
May 25, 2025 · Comprehensive analysis of global trends in Achilles tendon rupture incidence and the factors driving changes in occurrence rates.
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Epidemiology of Acute Primary Tendon Ruptures Presenting to ...
Oct 2, 2024 · The annual incidence of all tendon ruptures in the US increased significantly from 2001 to 2020 (AAPC=3.0, 95% CI=2.3-3.7; p<0.0001).
[111]
Achilles tendon complications of fluoroquinolone treatment
Jul 1, 2024 · Purpose The association between fluoroquinolone intake and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) is widely documented.
[112]
Recent developments in Achilles tendon risk-analyzing rupture ...
This review aims to summarize all significant factors determining the predisposition of the Achilles tendon to rupture, to develop effective personalized ...
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Protect Your Tendons | NIH News in Health
Exercise regularly to strengthen muscles around the joints. · Begin new activities or exercise routines slowly and gradually increase the intensity. · Position ...
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Eccentric Exercise for Achilles Tendinopathy: A Narrative Review ...
Jun 5, 2019 · Eccentric exercise has been associated with clinical benefit in improving pain and function for patients with Achilles tendinopathy.Missing: rupture | Show results with:rupture
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FDA advises restricting fluoroquinolone antibiotic use for certain ...
May 12, 2016 · Health care professionals should stop systemic fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a ...Missing: high- | Show results with:high-
[116]
Fluoroquinolones and Tendinopathy: A Guide for Athletes and ...
Patients prescribed both fluoroquinolones and corticosteroids had a 46-fold greater risk of Achilles tendon rupture than those taking neither medication.Missing: avoidance | Show results with:avoidance
[117]
Smoking and Musculoskeletal Health - OrthoInfo - AAOS
Rotator cuff (shoulder) tears in smokers are nearly twice as large as those in nonsmokers, which is probably related to the quality of these tendons in smokers.
[118]
Chronic Nicotine Exposure Alters Uninjured Tendon Vascularity and ...
Thus, clinicians may inform patients that nicotine in itself may alter tendons and that smoking-cessation treatment such as nicotine patches or gum may alter ...
[119]
Enhancing Functional Rehabilitation Through Orthotic Interventions ...
Nov 20, 2023 · In chronic cases of Achilles tendinopathy, custom-moulded foot orthotic devices have demonstrated efficacy in randomised controlled trials.Missing: equipment | Show results with:equipment
[120]
Controlled trial to compare the Achilles tendon load during running ...
Nov 13, 2019 · Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an ...
[121]
Ultrasound Screening of Achilles Tendon, Patellar Tendon ... - NIH
Nov 8, 2024 · The ultrasound findings may indicate that the athletes have been at risk previously, but now the tendon fibers have matured, demonstrating ...
[122]
Ultrasound as a predictor of time-loss injury for the patellar tendon ...
Oct 19, 2025 · Pre-season ultrasound screening should be considered in collegiate athletes to evaluate for the risk of developing injury during their sport ...
[123]
The effects of collagen peptide supplementation on body ... - NIH
Exercise and vitamin C seemed to aid collagen synthesis. 15 g/day COL was more effective than 5 g/day COL in elevating collagen synthesis, hence 15 g/day may be ...Missing: 2025 | Show results with:2025
[124]
Hydrolysed Collagen Supplementation Enhances Patellar Tendon ...
Mar 18, 2025 · Consuming 30 g hydrolysed collagen enriched with 50 mg vitamin C twice per week after resistance training (RT) led to greater increases in PT ...
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https://pmc.ncbi.nlm.nih.gov/articles/PMC11544750/
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Preventive factors against work-related musculoskeletal disorders
Ergonomic factors include awkward postures, continuous and excessive use of force, repetitive movements, working long hours without rest and poor working ...