What is a tendon tear?
Tendons are strong bands of tissue that attach muscle to bone. When you contract a muscle, the tendon pulls on the bone and moves it. Although your tendons are strong, they can get injured and partially or completely tear.
A partial tendon tear is similar to a frayed rope; part of it is torn, but it can still function. A fully torn tendon (sometimes called a ruptured tendon) can tear into two parts, or the tendon can be pulled away from where it attaches to bone or muscle.
Any tendon in the body can tear, but tears are more common in the shoulder, elbow, knee, back of the lower leg and heel.
What causes tendon tears?
Tendon tears most often occur from injuries and wear and tear (overuse or aging). For example, when you land from a jump with your knee bent, you are putting a significant amount of strain on your quadriceps muscles and on the tendon. That can cause the tendon to tear.
If a tendon becomes irritated from overuse, such as repetitively reaching overhead, it can become weaker and eventually tear.
Tears commonly occur in these tendons:
Your rotator cuff is made up of four muscles and several tendons that attach muscle to bone. The tendons in the rotator cuff can get injured or damaged from overuse, such as repetitively reaching overhead while painting, stocking shelves or swimming. The tendons can tear in the middle or from where the tendon attaches to the shoulder bone.
Biceps tendon (at the shoulder)
Your biceps muscle has two tendons that attach it to bones in the shoulder. One tendon connects the muscle to the top of the shoulder socket; this tendon is more likely to be injured. The second tendon attaches to a point on the shoulder blade. Injury and overuse can cause either tendon to partially or fully tear – for example, carrying something too heavy or falling on an outstretched arm.
Biceps tendon (at the elbow)
A tendon attaches the biceps muscle at the elbow. Most tears at this point are complete rather than partial. This type of injury is not common and usually is the result of injury. If this tendon tears, you will lose strength in your arm and will not be able to turn your palm up, as when turning a doorknob or screwdriver.
Quadriceps tendon (front of the thigh)
This tendon attaches the quadriceps muscle to the kneecap. Overuse or breaking a fall is the frequent cause of this type of tear. If the tendon is overused, it stretches and becomes inflamed, making it vulnerable to a tear. This type of injury is more common among middle-aged and older people, whose muscles and tendons have weakened with age.
Patellar tendon (knee)
The patellar tendon attaches the bottom of the kneecap (patella) to the top of the shinbone (tibia). A good deal of force is needed to tear the patellar tendon, such as falling directly on the front of the knee or landing after a jump with your knee bent. Tendon weakness, which can be caused by tendinitis or chronic diseases such as arthritis or diabetes, can make people susceptible to this type of injury.
Achilles tendon (back of the calf)
The Achilles tendon connects the calf muscle to the heel bone in the back of the foot. Tendinitis is the most common cause of Achilles tendon rupture, although sudden amounts of stress can tear it too. For example, sporadic participation in sports, falling from a height or stepping into a hole can all tear the Achilles tendon. These tears are common in recreational sports, including running, soccer, basketball, tennis, softball or hockey.
What are the risk factors for tendon tears?
- Age – Wear and tear that occurs over time can weaken the tendons.
- Joint overuse – Repetitively using a joint, such as swimming or regularly stocking overhead shelves, can put wear and tear on the tendons.
- Gender – Some types of tendon tears, such as in the Achilles tendon, are much more common among men than women. Experts believe it could simply be that men are more likely to engage in activities that overuse certain tendons.
- Corticosteroid use – These medications have been linked to muscle and tendon weakness.
- Certain chronic diseases – Some conditions, such as kidney or thyroid problems, diabetes, infection, arthritis or some cancers, can weaken the tendons.
- Immobilization – If you don’t move your muscles or tendons for some time, they can lose flexibility and strength, which can increase your risk of getting injured.
- Smoking – Cigarette smoke can affect the health of the tendon and may make it more susceptible to tearing.
- Tendinitis – Tendon inflammation can weaken the tendon and may cause tiny tears, which can increase the risk of a partial or complete tear.
- Use of certain antibiotics, such as fluoroquinolone (used for pneumonia, certain STDs, some urinary tract infections, etc.)
What are the symptoms of a tendon tear?
These will vary depending on the location and severity of the tear, but you may experience:
- Sudden, sharp pain around the injured area
- A “pop” or snap that you can hear at the time of the injury, particularly with the elbow or Achilles tendon
- Cramping in the nearby muscle
- Bruising around the site of the injury
- Pain or tenderness near the injury
- Difficulty moving the surrounding muscles
- Loss of motion, such as the ability to raise your arm (rotator cuff tear), turn your arm from palm up to palm down (biceps tendon tear at the elbow) or raise your leg (quadriceps tendon tear)
- An odd bulge or body part that seems out of place, such as a muscle bulge up near the shoulder (biceps tendon tear at the elbow) or a kneecap that appears to sag (quadriceps tendon tear)
How is a tendon tear diagnosed?
Your doctor will do a physical exam if he or she suspects a tendon tear. In some cases, the muscle may not be able to move the limb, or there is a gap in the tendon that your doctor can feel through your skin.
You may also have an obvious deformity, such as a “Popeye muscle” in your upper arm if you tear one of the biceps tendons and the muscle is no longer straight.
Your doctor may use certain imaging tests to better understand your injury, such as an X-ray or MRI.
What are the treatment options?
Your treatment will depend on the type of injury, severity, impact on your daily activities, your age, occupation and activity level.
Your doctor may suggest one or a combination of the following treatments:
- Rest and avoiding activities that aggravate the injured area
- Applying ice several times a day for 15 to 20 minutes at a time to reduce pain and inflammation
- Wrapping the injured area with an ACE bandage or other means of compression to minimize swelling
- Elevating the injured area to reduce swelling
- Over-the-counter medications, such as acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil), to ease pain and swelling
- Physical therapy and exercises to strengthen and stretch the injured area after pain and swelling have gone done; recovery and rehabilitation are important to prevent re-injury
- Wearing a cast, brace or sling to immobilize the affected area if the tendon is partially torn; this helps keep you from using the affected area while it heals
- Surgery if the tear is complete, severe or accompanied by other injuries.
If surgery is needed, the procedure will re-anchor the tendon to the bone or sew together a tendon that is torn in the middle. Schedule the surgery as soon as possible. Some tendon injuries cannot be operated on if too much time has passed because the tendons and muscles can scar and shorten.
How are tendon tears prevented?
- Stay at a healthy weight.
- Avoid activities or movements that put excessive stress on already injured tendons or areas of the body that are painful.
- If you notice pain when you are exercising or working, take a break.
- Warm up properly before exercising.
- Maintain good muscle strength and flexibility.
- If you have pain that doesn’t go away after a couple weeks, get checked out by a doctor. Not taking care of an injury can create a more serious problem later. For example, untreated tendinitis can lead to a tendon tear
What is the short- or long-term impact of a tendon tear?
Treatment and recovery takes time, and the impact of a tendon tear can vary depending on the location of the tear.
Rotator cuff tendon
Not everyone with a rotator cuff tear needs surgery. Your pain and range of motion may get better without surgery, but your strength will not improve. If you have surgery, the path to recovery is long: Most people wear a sling for four to six weeks after surgery and have to limit their shoulder motion.
Rehabilitation can take another six to 12 weeks. Most people are able to move their shoulder and have adequate strength four to six months after surgery, although further rehab may be needed to increase range of motion and strength.
Also, the original tendon tear may have been caused by tendinitis or bursitis; nonsurgical treatments may focus on treating those conditions, as well.
Biceps tendon (shoulder)
Not everyone who has a complete biceps tendon tear needs surgery. One tendon usually still attaches the muscle to the shoulder and allows for continued – although more limited – use of the arm.
Rotator cuff injuries, shoulder impingement and tendinitis may accompany this type of tear, but if there aren’t additional injuries or damage, you may get better with noninvasive treatment.
Athletes or people who do manual work may opt for surgery if they need full strength and range of motion.
Biceps tendon (elbow)
The biceps tendon will not re-attach to the bone if torn, and you may suffer significant, permanent weakness in the arm without surgery. Nonsurgical treatment is usually only discussed if you are older and inactive or if you have a health condition that could prevent a successful surgery.
The biceps tendon can take two to three months to fully heal after surgery. It’s important to follow your doctor’s instructions and restrict your activities. Most people are able to do light lifting soon after surgery, but heavy lifting is generally restricted until several months after surgery.
Quadriceps tendon (knee)
If the tear is partial and small, you may not need surgery, but you will likely wear a knee immobilizer or brace for three to six weeks. Afterward, you should gradually add exercises to restore strength and range of motion – rehabilitation should take around six months.
If you have surgery, you’ll likely have the stitches or staples out after about two weeks. Your doctor will then protect your knee with a knee immobilizer or long leg cast. You may need to use crutches or a walker to get around, and your doctor will design a rehab plan to help you regain strength and range of motion.
Individual recovery time varies from one person to the next, but it can take four to 12 months.
Patellar tendon (knee)
If you have a very small, partial tear, your doctor may suggest a knee immobilizer or brace for three to six weeks. You can start with physical therapy, such as quadriceps muscle strengthening exercises, while wearing the brace.
After the brace is off, your doctor or a physical therapist will recommend additional exercises to increase your strength and range of motion.
If you have surgery, your doctor will take the sutures or staples out after about 2 weeks. Between two to four weeks afterward, your leg should be able to hold about half of your body weight. It will take four to six weeks for your leg to hold your full body weight.
Complete recovery can take six to 12 months. Most people can return to their jobs after recovering from this type of injury, although they may have some stiffness.
For both a partial or complete tear, your doctor may recommend a splint for four weeks to immobilize the ankle and prevent pulling on the Achilles tendon. An exercise rehabilitation program may follow and continue up to six months, although you should be able to slowly resume your activities during this time.
Surgery is often used to repair an Achilles tendon tear to prevent re-rupture. Also, the recovery time can be shorter if you have surgery. After the torn tendon is stitched back together, you will likely have to wear a walking boot, cast, brace or splint for six to eight weeks to give the tendon time to heal.
Most people who tear their Achilles tendon, with either surgical or nonsurgical treatments, resume their former level of activity within four to six months of the injury.
Questions to Ask Your Doctor
- Could I have a torn tendon?
- Is the tear partial or complete?
- What are the possible treatment options? What if I don't have treatment?
- Would you recommend surgery? What are the benefits and risks?
- Are some treatment options more effective than others in reducing risk of future tendon tears?
- Will I have temporary or permanent weakness, pain or loss of strength?
- What does the recovery timeline look like?
- When can I start doing light activities and more intensive activities?
- Will I need to take leave from work to recuperate?
- What can I do at home to relieve my symptoms or take care of the injury?
- Do you recommend or advise against immobilizing the injury (e.g., using a sling or a brace)? Why?
- Do you recommend heat and/or ice?
- Do you recommend any medications?
- What are some ways I can prevent the injury from recurring or getting worse?
- What is my long-term outlook with this type of injury?
Our Medical Advisory Board
Wiser Motion's physician advisors review all information on the site to ensure its accuracy, relevance, and consistency with medical best practices.
James Herndon, MD
Orthopaedic surgeon at Massachusetts General Hospital (Boston, MA) and Professor at Harvard Medical School
Leslie Scott Matthews, MD
Chief of Orthopaedic surgery at the Union Memorial Hospital (Baltimore, MD) and Asst. Professor at Johns Hopkins Hospital
Peter Johnson, MD
Medical Director of occupational medicine and employee health at the McLeod Regional Medical Center (Florence, SC)