Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Partial Tendon Rupture

In partial tendon rupture (first- and second-degree strains), the tendon is only partly torn. Depending on the extent of the injury, the affected athlete may not always be aware that a rupture has occurred, but believes the tendon to be overused and inflamed. Partial ruptures can be divided into acute and chronic injuries.

Symptoms and diagnosis

Acute partial tendon rupture may become apparent as follows:
– A history of a sudden onset of pain often in combination with a specific event or movement.
– Pain occurs in the injured area on further activity and when movements in adjacent joints are made against resistance.
– A localized distinct tenderness is present in the injured area.
– Swelling, and sometimes a hematoma, may occur.
– A small, tender defect can be felt in the tendon soon after the injury.

Chronic partial tendon rupture may become apparent as follows:
– A history of sudden pain is common but often no trauma can be remembered.
– Pain may be experienced during warm-up but may then disappear, only to reappear with greater intensity later.
– Pain may be elicited in the injured area by moving the adjacent joints against resistance.
– A localized distinct tenderness may be present.
– Some swelling may be seen.
– An MRI or an ultrasound examination will show the location and extent of the injury.

Location

The tendon most frequently affected by both acute and chronic partial rupture is the Achilles tendon; the injury may also occur in the patellar tendon, rotator cuff tendons, and the adductor longus tendon.


Treatment

The athlete or trainer should give immediate treatment to an acute partial tendon rupture as follows:
– treat with ice, compression bandage, rest, and elevation; sometimes crutches can be of value;
– consult a doctor to confirm the diagnosis and thereafter decide upon further treatment.
The doctor may:
– apply a plaster cast, a walking boot, or supportive bandage, especially during the acute phase;
– prescribe an exercise program of gradually increasing intensity;
– prescribe anti-inflammatory medication.
If an acute partial tendon rupture is inappropriately treated, inflammatory tissue will form in the injured area and heal only with difficulty. If the healing is prolonged, chronic inflammation may result, giving the same symptoms as chronic tendinitis. It is, therefore, essential that these injuries are treated correctly from the start. When neglected, they can be among the most difficult of all sports injuries to treat. In cases of chronic rupture (tendinosis) the athlete or trainer should:
– try an exercise program including a combination of stretching and eccentric exercises;
– try physical treatment methods;
– use a supportive bandage, tape, or brace to unload the injured area;
– use a heat retainer.
The doctor may:
– prescribe anti-inflammatory medication;
– operate if the symptoms are prolonged and incapacitating.

Even small partial ruptures should be treated with great concern and respect, otherwise they will heal with scar and granulation tissue. These can cause further problems and lead to a chronic condition which is often very difficult to treat. The need for surgery seems to increase with the duration of symptoms from the tendon. If a patient has had an Achilles tendon injury for more than 22 months, there is a 38% chance of operative treatment. About 10–20% of athletes with Achilles tendon overuse injuries are operated on sooner or later, and about 70–80% of these athletes make a successful comeback. It takes, however, 6–8 months to full recovery. Repeat surgery is required by 10–20%, and 3–5% are forced to abandon their athletic career.

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