Tendon Rupture

First aid for a suspected tendon rupture

1. Stop activity immediately.
2. Rest and protect the limb; avoid putting weight on a leg injury.
3. Apply ice wrapped in a cloth for 15 to 20 minutes every 2 to 3 hours.
4. Elevate the limb to limit swelling.
5. Use acetaminophen (paracetamol) or ibuprofen for pain, following the label dose.
6. See a doctor promptly, ideally within a few days, as some repairs are best done early.

Common tendon ruptures

Causes and risk factors

• sudden forceful muscle contraction, especially when the tendon is stretched
• weekend athletes doing occasional high-intensity sports
• age-related tendon degeneration and previous tendinitis
• fluoroquinolone antibiotics (ciprofloxacin, levofloxacin), especially in people over 60 or taking steroids
• corticosteroid injections into or near a tendon, and long-term oral steroids
• chronic kidney disease, diabetes, gout, rheumatoid arthritis, lupus
• obesity
• anabolic steroid use

Diagnosis

• examination: strength testing, feeling for a gap, special tests such as the Thompson test (squeezing the calf to check if the foot moves) for the Achilles
• ultrasound: quickly shows complete or partial tears
• MRI: for detailed assessment and surgical planning
• X-rays: rule out fractures or bone fragments pulled off with the tendon

Treatment

Non-surgical

• immobilization in a cast, boot or splint, sometimes with heel wedges for the Achilles
• early controlled movement and rehabilitation; for Achilles ruptures, modern non-surgical "functional" protocols produce results similar to surgery for many people
• physical therapy to restore strength and range of motion

Surgical repair

• the torn ends are stitched together or the tendon reattached to bone with anchors
• recommended for most quadriceps, patellar and distal biceps ruptures, many rotator cuff tears in active people, and Achilles ruptures in some athletes or delayed cases
• earlier surgery is easier because the tendon retracts and scars over time

Recovery

Recovery often takes 4 to 12 months. Rehabilitation progresses from protecting the repair, to restoring motion, to strengthening and return to sport. Rerupture is possible if activity returns too soon.

Prevention

• warm up and increase training gradually
• strengthen and stretch calf, thigh and shoulder muscles
• avoid sudden intense activity after long inactivity
• discuss tendon risk before taking fluoroquinolones, especially with steroids or over age 60
• do not ignore persistent tendon pain

Frequently asked questions

How do I know if I ruptured a tendon?

Typical signs are a sudden pop or snap, sharp pain, swelling and bruising, and immediate weakness or inability to use the joint normally, such as not being able to rise on tiptoe or straighten the knee. A gap may be felt in the tendon.

Can a ruptured tendon heal without surgery?

Some can. Many Achilles ruptures heal well with a boot and structured rehabilitation, and long-head biceps ruptures at the shoulder often need no surgery. Quadriceps, patellar and distal biceps ruptures usually need surgical repair to restore function.

How long does it take to recover from a tendon rupture?

Most people need 4 to 12 months to recover fully, depending on the tendon and treatment. Walking may return within weeks, but returning to sports often takes 6 to 12 months of rehabilitation.

Can antibiotics cause tendon rupture?

Yes. Fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin, increase the risk of tendon inflammation and rupture, especially the Achilles, in people over 60, those taking steroids and transplant recipients. Stop the medicine and contact your doctor if tendon pain develops.