How Do You Tell If a Tendon Is Torn or Strained?

Tendons are cord-like fibrous tissue structures that connect muscles to bones. Thus, a tendon has two ends, one of which attaches to the muscle, whereas the other connects with the outer covering of the bone (periosteum).

At certain sites, such as the wrist and foot, the tendons are covered by tendon sheaths. A tendon sheath is a fibrous, fluid-filled structure that protects the tendon at sites where it may pass over bony and uneven surfaces.

Tendons enable movements when the muscles contract (shorten) and relax (lengthen). They act like efficient space-saving structures that enable proper attachment between muscles and bones even when there is not enough space on the bone for the muscle to attach directly or when the muscle and the bone are far apart.

• Thousands of tendons are present in the human body.
• They participate in almost every movement, right from the movement of the eyes to the toes. They also enable you to maintain proper posture and balance.
• The shape and size of the tendons vary depending upon the site where they are present and the functions they perform.
• The Achilles tendon present at the back of the leg is the largest and strongest tendon in the human body. It connects the calf muscles to the heal.

Tendons also help prevent muscle injuries by taking some of the force from the muscles during movements.

Although tendons are quite strong, they lack stretchability. Hence, they may develop breaks or tears in some of their fibers when they get stretched beyond a limit. Sometimes, a tendon may be inflamed due to a disease or injury, a condition called tendinitis.

To diagnose a tendon injury, your doctor will:

• Take detailed medical history including any past injuries, your usual activities, job, any underlying conditions you may have, medications you are on, and sports you participate in.
• Perform a detailed physical examination to know the type and severity of the injury.
• Order certain investigations such as:
  • X-ray
  • Computed tomography scan
  • Magnetic resonance imaging
  • Ultrasonography

They may also remove a sample of fluid from your arthrocentesis (joint space) using a needle after the application of numbing medicine. The collected fluid (called synovial fluid) will then be sent for lab examination.

Your doctor may also order other relevant tests including blood tests to exclude any conditions that may have caused your symptoms or that can affect your treatment and recovery.

It is unlikely that a tendon injury will heal on its own without proper care. Tendons do not have a rich blood supply like muscles and thus may take more care and time to heal.

Most minor strains can be managed at home; however, more severe injuries involving significant tears in the tendon fibers may need hospitalization.

The treatment of tendon tears may also vary depending upon the site of the injury, the person’s general health, and any underlying conditions they may have and may include:

• Rest: Adequate rest coupled with the cessation of any activities that may worsen the symptoms is important.
  • Giving rest to the affected site helps in faster recovery and prevents worsening of the injury.
  • If, however, a person cannot completely avoid certain activities, they may be reduced in intensity and frequency if the treating doctor permits.
  • In some cases, the doctor may apply a cast or splint to immobilize the ruptured tendon.
• Ice packs: The application of ice packs helps relieve pain and swelling.
  • Do not apply ice directly to the skin. Use ice packs or ice wrapped in a soft towel.
  • Avoid the application of ice packs for more than 20 minutes at a time.
• Compression and elevation: Tendon injuries may result in significant swelling.
  • The swelling may worsen with time leading to worsening of the symptoms. 
  • You may apply a bandage around the affected site to reduce swelling and take your provider’s help to know how tight the bandage should be.
  • Avoid tying it too tight as it may reduce blood supply to the site.
  • Try elevating the affected area above the level of your heart. This will also prevent fluid collection and resultant swelling at the affected site.
• Medications: The doctor may prescribe medications to reduce pain and swelling. 
  • These include nonsteroidal anti-inflammatory drugs and acetaminophen tablets.
  • Topical nitroglycerin patches may also be prescribed to reduce symptoms and promote healing.
  • Steroids in the form of oral medications or injections may be given in severe cases.
• Assistive devices: They help reduce the tendon movement allowing it to heal better. 
  • Assistive devices include braces, splints, crutches, walkers, and slings.
  • They help minimize further tendon injury and reduce the burden or pressure at the affected site.
• Physical therapy: Your doctor may recommend physical therapy to reduce symptoms, increase strength, and regain limb functions.
  • Physical therapy may continue for weeks to ensure that you have attained sufficient strength and range of motion.
  • It may also help reduce the risk of future tendon injuries.
• Ultrasound-guided percutaneous tenotomy: This procedure involves passing a needle under ultrasound guidance into the tendon to promote healing.
  • It may be tried in severe cases that do not respond well to medications.
• Surgery: It may be needed in severe cases that do not respond to conservative treatment.
  • The type of surgery you need will depend upon the severity of the tendon rupture and the site involved.
  • You may require physical therapy after surgery to aid recovery.