Treatment

All ruptured tendons, regardless of site, follow standard RICE (Rest, Ice, Compression, Elevation).

• Resting the affected extremity.
• Ice application to the affected area.
• Compression of the affected area to minimize swelling.
• Elevation of the extremity if possible:
• It is recommended that the quadriceps rupture should be immobilized in an extended (straight knee) position and that biceps rupture should be immobilized in a sling with elbow bent at 90%.

Treatment for specific ruptures

• Quadriceps
• Achilles tendon
• Rotator cuff (shoulder)
• Biceps

Quadriceps

• Partial tears may be treated without surgery by placing a straight leg in a cast or immobilizer for 4-6 weeks.
• Unless the doctor is sure that the injury is a partial tear, surgery will be done to repair the tendon.
• Post operation, the part is immobilised as for a partial tear.
• With physiotherapy, the injured leg should re-gain full function within 6 months.

Achilles tendon

• Treatment without surgery involves placing the foot so that the sole of the foot is pointed downward for 4-8 weeks.
• This treatment has been advocated by some because it gives similar results to surgery in motion and strength. The problem with this treatment is that it has a re-rupture rate of up to 30%. Nevertheless, it may still be a reasonable option for those who are at increased operative risk because of age or medical problems or inactive people who may tolerate mild weakness in supporting weight on the ball of your foot (called plantarflexion).
• Surgery to repair the Achilles tendon is recommended for active people who desire near normal strength and power in plantarflexion. An additional advantage with surgical correction is a lower re-rupture rate of the tendon.
• After the operation, the foot will be immobilized with toes pointing downward for 3-4 weeks and then progressively brought into neutral position over 2-3 weeks before weight-bearing is started. Surgery carries with it a higher risk of infection than closed treatment.

Rotator cuff (shoulder)

The rotator cuff is unique because treatment without surgery is the treatment of choice in most tendon injuries. More than 90% of tendon injuries are long term in nature, and 33-90% of these chronic rupture symptoms go away:

• Without surgery.
• In contrast, acute rupture, as occurs with trauma, may or may not be repaired surgically depending on the severity of the tear.
• If the tear is either less than 50% of the cuff thickness or less than 1 cm in size, the dead tissue is removed arthroscopically. A small incision is made and a tool called an arthroscope is passed into the joint. Through it, the surgeon can see and remove dead tissue without actually cutting the joint open. The shoulder is then left to heal.
• Many surgeons will not attempt surgical repair until non-operative treatment has failed, even in cases of larger tears.
• Surgical treatment is usually reserved for a severe tear in a young person or in an older person (aged 60-70 years) who is suddenly unable to externally rotate their arm.
• Acromioplasty, removal of the coracoacromial ligament and repair of the rotator cuff tendon, usually results in near full rotator cuff strength.

Biceps

• Most surgeons prefer not to operate on a ruptured biceps tendon because function is not severely impaired with its rupture.
• Studies suggest that after biceps rupture, only a small fraction of elbow flexion is lost and approximately 10-20% strength reduction in supination (ability to turn the hand palm up). This is considered to be a moderate loss and not worth the risk of surgery in middle-aged and older people.
• In young people unwilling to accept the loss of function and mild deformity involved with this injury, surgery is performed to repair the tendon.
• Surgery is also considered for the middle-aged person who requires full lower arm rotation strength in their line of work.
• The arm is left in a sling for a few days after surgery and then used as tolerated. After surgery, full function normally returns after 12 weeks.