Tendon Rupture

A tendon rupture is a serious injury where the thick tissue connecting muscle to bone tears completely or partially, causing severe pain and loss of function that can take months to heal.

Table of contents

• What is a tendon rupture?
• Commonly affected areas
• Causes and risk factors
• Symptoms
• Diagnosis
• Treatment options
• Recovery and rehabilitation

What is a tendon rupture?

A tendon is a strong band of fibrous tissue that connects your muscles to your bones^[1]. These tissues are designed to handle significant force—sometimes more than five times your body weight^[1]. When a tendon stretches beyond its capacity, it can tear or rupture^[2].

A tendon rupture can be either partial or complete^[3]. A partial tear means some of the tendon fibers are still intact, like a rope that is frayed but still holding together. A complete tear means the tendon has separated entirely, and the two ends are no longer connected^[3]. Although fairly uncommon, a tendon rupture can be a serious problem and may result in severe pain and permanent disability if left untreated^[1].

Commonly affected areas

• Achilles tendon (back of ankle)
• Rotator cuff (shoulder)
• Quadriceps tendon (above kneecap)
• Patellar tendon (below kneecap)
• Biceps tendon (shoulder and elbow)

The four most common areas where tendon ruptures occur include the quadriceps, Achilles, rotator cuff, and biceps^[1].

The quadriceps tendon is formed by four muscles that come together just above your kneecap. This group of muscles helps you extend your leg at the knee and is essential for walking, running, and jumping^[1].

The Achilles tendon is located on the back of your foot just above the heel. It connects your calf muscle to your heel bone and is the largest and strongest tendon in your body^[4]. This tendon is vital for pushing off with your foot, standing on your toes, and starting to run^[1].

The rotator cuff in your shoulder is actually composed of four muscles that work together to raise your arm, rotate it, and keep your shoulder stable^[1]. Rotator cuff tendon injuries are among the most common in the body, with studies showing that 8% to 20% of examined individuals have rotator cuff tears^[1].

The biceps tendon in your arm helps you bend your elbow and bring your hand toward your shoulder. Ruptures of the biceps are classified as proximal (near the shoulder) or distal (near the elbow), with distal ruptures being extremely rare^[1].

Causes and risk factors

Tendon ruptures typically occur when a very strong force is applied suddenly, stretching the tendon beyond what it can handle^[4]. This often happens during sports activities that involve sudden stops, starts, or changes in direction—such as soccer, football, basketball, tennis, or squash^[6].

In general, tendon rupture occurs more often in middle-aged or older individuals^[1]. In younger people, the muscle usually tears before the attached tendon does. However, as you age, your blood supply decreases, which reduces blood flow to the tendon and results in weakening^[1]. People who are “weekend warriors”—adults who don’t train regularly but then exercise at high intensity—are more likely to tear a tendon than younger, well-trained athletes^[6].

General causes of tendon rupture include direct trauma, advanced age, and eccentric loading—when your muscle contracts while being stretched in the opposite direction, placing increased stress on the involved tendon^[1]. Everyday accidents like tripping, falling, or twisting your ankle can also cause ruptures^[4].

Certain conditions make a rupture more likely. These include diseases such as gout and hyperparathyroidism, as well as having type O blood^[1]. The injection of steroids into a tendon, sometimes used to treat severe tendonitis, can also increase rupture risk^[1]. Additionally, certain antibiotics—specifically fluoroquinolones—have been shown to increase the risk for tendon rupture, particularly of the Achilles tendon^[1].

Symptoms

Severe pain is the first and most obvious symptom of a ruptured tendon^[2]. Many people describe feeling or hearing a pop or snap at the moment of injury^[4]. The sensation is often compared to being kicked or struck in the affected area, though nothing has actually hit you—you’re feeling the tendon snap^[6].

Other common symptoms include rapid bruising and swelling at the site of injury^[2]. You may experience an inability to bear weight on the injured leg or ankle, weakness, and restricted movement in the affected body part^[2]. Sharp, sudden pain may fade into a dull ache but typically worsens with movement^[6].

In some cases, you may be able to feel a gap in the tendon where it has separated, and there may be a visible indentation at the injury site^[6]. For Achilles tendon ruptures specifically, people often have difficulty walking, especially when going upstairs or uphill, and cannot stand on their toes on the injured leg^[4].

Diagnosis

Your healthcare provider will start by physically examining the affected area^[6]. They will check your ability to move the joint in various directions and observe how you react to pressure on the area^[6]. The doctor may be able to feel a gap in the tendon that indicates it has torn^[6].

For suspected Achilles tendon ruptures, your doctor might perform the Thompson test. This involves squeezing your calf muscle while you lie face-down. If your foot doesn’t flex in response, a rupture is likely^[14].

Your provider may also use imaging tests to confirm the diagnosis and assess the extent of the tear^[6]. Ultrasound and MRI (magnetic resonance imaging) scans are commonly used because they create detailed images of the soft tissues in your body^[4]. These painless procedures help determine whether the rupture is complete or partial, which is important for planning treatment^[4].

Treatment options

Treatment for a ruptured tendon depends on several factors, including the severity of the rupture, which tendon is affected, your age, activity level, and overall health^[5].

Immediate care

Before you receive medical treatment, you can reduce pain and swelling by following the RICE method^[6]:

• Rest by staying off the injured leg or avoiding use of the affected area
• Apply ice to the injured area
• Use compression by wrapping the area to prevent more swelling
• Elevate your leg at or above the level of your heart to reduce swelling

You can take over-the-counter pain relievers such as ibuprofen or acetaminophen for pain management^[5]. You may also need to use crutches to take weight off the affected area and wear a boot for support^[5].

Nonsurgical treatment

For some tendon ruptures, particularly partial tears, nonsurgical treatment may be appropriate^[10]. This approach typically involves resting the tendon, applying ice, and keeping the affected area immobilized for several weeks—usually with a walking boot, splint, or cast^[5].

The boot or cast keeps your foot or joint from moving, which prevents further injury and allows the torn tendon ends to heal together^[6]. For Achilles tendon ruptures treated nonsurgically, you typically wear the boot for about six to ten weeks, with your foot held in a tip-toe position^[10].

Nonoperative treatment avoids the risks associated with surgery, such as infection^[10]. However, recent studies indicate that recovery can take longer with this approach, and there may be a slightly higher chance of the tendon rupturing again^[10].

Surgical treatment

Younger and more active people, particularly athletes, often choose surgery to repair a completely ruptured tendon^[10]. Surgery involves reconnecting the torn tendon ends, which can be done through several different techniques^[5].

Traditional open repair surgery has been shown to have lower rates of the tendon rupturing again, but it carries a higher risk of complications such as wound infection^[14]. Newer techniques, including percutaneous (through small punctures) and mini-open repair, show similar success rates with fewer overall complications^[14].

After surgery, you will need to wear a boot or cast to protect the repair while it heals, typically for about eight to ten weeks^[14]. Your doctor will provide specific instructions about when you can begin bearing weight on the affected leg^[10].

Recovery and rehabilitation

Full healing of a torn tendon typically takes about four to six months, regardless of whether it is treated surgically or nonsurgically^[6]. However, long-term outcomes indicate that significant loss of strength and function can persist for up to two years after the injury is repaired^[14].

With the help of physical therapy, most people can return to normal activity in four to six months^[6]. Physical therapy is essential and typically begins once your doctor determines it is safe to start moving the affected area—usually two to three weeks after injury for nonsurgical treatment, or after the surgical repair has had time to stabilize^[10].

In physical therapy, you will learn exercises to improve flexibility and make the affected muscles stronger^[6]. The rehabilitation program typically progresses through several phases. Initially, the focus is on gentle range of motion exercises and reducing stiffness^[5]. As healing progresses, weight-bearing exercises are gradually introduced to rebuild functional strength^[5].

Functional rehabilitation combining protected weight-bearing and early controlled motion has been shown to effectively reduce the risk of the tendon rupturing again while producing satisfactory outcomes^[14]. When you stretch the affected muscles, do so slowly, and avoid bouncing or using too much force^[6].

Many patients report activity limitations for at least six months, and true full recovery can take a year or more^[21]. Most rehabilitation programs reach the point where you can resume sports and physical work after six months, although the exact timing depends on the specific activity and your individual progress^[21].

After you heal, you are at greater risk for injuring the same tendon again^[6]. To prevent re-rupture, it is crucial to wear the boot or brace as instructed for the full duration—typically ten weeks—without taking shortcuts^[21]. You should stay in good shape, stretch before exercising, avoid high-heeled shoes if you’ve had an Achilles rupture, and do proper warm-up and stretching before returning to sports^[6].