Sehnenriss

Tendon tear: description

Muscle tendons usually tear only when they are already damaged by wear and then exposed to excessive stress (such as during sports). One distinguishes complete tears from partial tears of the muscle tendons. Complete tendon tears mainly affect men between 20 and 50 years.

Muscle tendons transmit muscle power to the bone, which usually results in movement or at least preload. They consist of a rough, less elastic and tension-resistant fabric. The tendon material contains a few cells, the so-called tendinocytes. These can divide slowly, continually renewing the tissue or repairing an injury. However, this usually takes a relatively long time. Most tendons are surrounded by a sheath that serves as a guardrail.

biceps tendon

In a biceps tendon rupture (biceps tendon rupture), one of the tendons is severed, attaching the arm flexor muscle (biceps muscle) to the shoulder or forearm. The biceps muscle is the most important flexor of the elbow joint and one of the most important shaping muscles on the front of the upper arm. He has three tendons: In the upper part he is connected via two tendons (long and short biceps tendon) with the shoulder, in the lower part of a tendon (lower biceps tendon) with the radius on the forearm:

Particularly vulnerable to injuries is the long biceps tendon, Chronic damage to the shoulder joint can cause inflammation (tendovaginitis bicipitis) to the point of complete biceps tendon rupture. A biceps tendon rupture short biceps tendon is very rare. Occasionally, the tears also lower biceps tendon.

Flexor tendon injuries on the hand

Each finger has two flexor tendons, one superficial and one deeper. They connect the fingers with the flexor muscles in the forearm. In their course, the flexor tendons are protected and guided by tendon sheaths. Several bands keep the tendons close to the bone. A flexor tendon injury on the hand is always severe because of the specific anatomical conditions. However, there are now effective surgical and post-treatment procedures that produce successful results.

Extensor tendon injury

An extensor tendon injury occurs when one of the two extensor tendons, which run from the musculature on the forearm to the back of the hand to the fingers, tears. The extensor tendons are closely linked, especially the tendons of the fingers four and five. At the level of the wrist, the extensor tendons are protected by sheaths – the so-called tendon sheaths. In order for a stretching tendon to break, larger forces usually have to work – except at the end member of the fingers. At this point, even slight forces can lead to a stretching tendon rupture. Physicians then speak of a “covered stretched tendon”.

Quadriceps tendon rupture / patellar tendon rupture

In quadriceps tendon rupture, the tendon that connects the thigh extensor (quadriceps) to the kneecap (patella) ruptures. In patellar tendon rupture, the ligament is torn, leading from the patella to the lower leg. Both tendons belong to the extensor apparatus of the leg and help with the transmission of power from the thigh to the lower leg.

Further information: Achilles tendon tear

Everything important about a rupture of the Achilles tendon can be found in the article Achilles tendon rupture.

Further information: Tendon tear – shoulder

For a tendon tear on the shoulder, see Tendon tear – shoulder.

Tendon tear: symptoms

The symptoms of a tendon tear typically occur suddenly and immediately after the rupture. In the foreground are usually less the pain than the functional failure (such as a loss of power when kneeling, if the quadriceps tendon or patellar tendon is torn). However, if the tendon is already significantly damaged, so that a permanent pain, this can also be improved by the tendon tear. Other symptoms of tendon rupture are usually swelling and bruising. The neighboring nerves and vessels may also be injured. Sometimes a tendon tear is accompanied by an audible bang.

biceps tendon

In a biceps tendon rupture, the biceps muscle belly slips visibly: a rupture of the lower biceps tendon causes the biceps muscle to move upwards, while the upper biceps tendon tears down the muscle belly. In addition, sufferers notice a functional impairment, such as lifting the forearm.

Flexor tendon injury of the hand

If both flexor tendons of a finger tear, a powerful flexion of the finger is no longer possible. If only the deep flexor tendon is affected, the patient can no longer only bend the end member of the affected finger. Other symptoms include swelling and bruising.

Extensor tendon injuries

If the tendon tear affects the extensor tendon on the hand, the affected person can no longer stretch the affected finger vigorously. If the extensor tore on the end member, this phalange hangs down. This means that the patient can no longer stretch the end member, resulting in a so-called “Hammer-Finger. “This type of injury accounts for about one-third of all extensor tendon injuries.

Quadriceps tendon rupture / patellar tendon rupture

In a quadriceps tendon rupture, a palpable dent above the patella points to where the tendon is torn. The kneecap is deeper than normal (patellar depression). Patellar tendon rupture has a dent below the kneecap, which is higher than normal (patellar high). In both cases, the knee can not be actively stretched. In addition, the patient can no longer stand securely on the affected leg alone.

Tendon rupture: causes and risk factors

A tendon rupture is often the result of an accident in which the corresponding tendon is subjected to an unusually heavy load. A complete tendon tear usually only occurs when the tendon is already damaged or torn. Such previous damage can be caused either by repeated minor injuries or by chronic overloading. In addition to wear and tear due to physical activity and obesity, chronic diseases such as gout and diabetes mellitus are risk factors for tendon rupture.

In a tendon rupture sometimes a bone fragment is torn out of the attachment of the affected tendon. Physicians then speak of a demolition fracture.

The most common cause of a biceps tendon are sports injuries. In the case of a rupture of the long biceps tendon on the shoulder, in most cases the so-called rotator cuff is also injured – a four-part muscle group in the shoulder area. The short biceps tendon, the approach of the biceps muscle on the forearm, ruptures especially in case of sudden stress.

The Flexor and extensor tendons of the hand tear especially by an external violence such as cuts or animal bites. Stretching tendons can also tear during sports.

The typical injury pattern of a Quadrizepssehnenruptur is the tension of the muscle against a resistance such as when stumbling. Very often, the tendon is already damaged.

Tendon tear: examinations and diagnosis

If you suspect a tendon tear, you should contact an orthopedic surgeon or accident surgeon. He can often diagnose a tendon rupture with certainty based on the typical symptoms. The muscle function and flexibility can be tested with various tests. In addition, tissue perfusion and sensitivity are also examined.

In ultrasound (ultrasonography), tendon rupture is usually easy to recognize, for example through a gap in the course of the tendon. X-rays can not represent soft tissues like tendons. However, X-ray images can provide indirect evidence of tendon rupture, such as in the form of a tear fracture or a patella displaced up or down (for patellar tendon rupture or quadriceps tendon rupture).

If the diagnosis is not clear, MRI (magnetic resonance imaging, MRI) can help.

Tendon tear: treatment

A tendon rupture can in principle be treated conservatively as well as surgically. Which therapy procedure is to be preferred in individual cases depends primarily on the affected tendon. The appropriate procedure should therefore be discussed individually with the attending physician.

If the tendon is completely torn in two, the doctor can reconnect the two ends during surgery. Depending on the type of injury also Sehnendurchflechtungen and wire seams come into question. In order to attach a tendon to the bone again Reinsertion), various surgical procedures are available: suture, hanging or anchoring to the bone and looping of the bone. Complications such as bleeding, infection, thrombosis or tearing of the suture are rare.

Biceps tendon rupture

A biceps tendon tear can often be treated conservatively (first immobilization, then movement exercises). If this does not succeed, both a tear of the long and the short biceps tendon is usually operated on. After surgery, the arm is initially not fully loadable. A physiotherapy keeps the joints flexible and trains the muscles. The burden is gradually increased.

In older people with a rupture of the long biceps tendon doctors often do without surgery. Instead, the arm must be protected until there is no more pain. The elbow-abducted muscle belly remains permanently in this position. A tear of the short biceps tendon, on the other hand, is usually operated on in older people as well, since the loss of strength is much greater than with the rupture of the long biceps tendon.

Flexor tendon injury on the hand

In the event of a flexor tendon injury, suturing the tendon stumps within six hours of the tear promises the best therapeutic results. Surgery under local anesthesia is not always possible because the proximal tendons of the tendons have often slipped back in the direction of the forearm through the muscular traction.

In the case of older or infected flexor tendon injuries of the hand, where a direct suture may not be advisable, the physician will first place a silicon pin (sap) in the tissue and thereby prevent the tendon sheath from sticking together. In a second operation, the surgeon reassembles the tendon or performs a tendon transplant.

In flexor tendon injuries, there is no suturing technique that allows for full loading of the tendon. The tendon must be gently moved in the dressing so that it does not stick in the tendon sheath, which would stiffen the affected finger.

A special aftercare after surgery aims to combine passive, powerless flexion of the affected finger with an active, powerful stretch: the patient is given a special splint (Kleinert splint) that prevents the fingers from fully extending. On the fingernails rubber bands are attached, which are attached in the carpal area. This allows the patient to stretch their fingers against the tension of the elastic bands or to bend them passively.

Six weeks after surgery, the splint is usually removed; a full load capacity is possible again after twelve weeks.

Extensor tendon injury

Among other things, the treatment of extensor tendon injury depends on which tendon is ruptured at which point and whether the tear is partial or complete. If the tendon is completely severed, the tendon stumps should be sewn together within a short time; this promises the best results.

Stretching tendons, in contrast to the flexed tendons, can not “slip back” far. A fresh extensor tendon injury can usually be treated under local anesthesia. In the case of stretchline tears on the final limb, a special brace is applied (as long as the residual stretchability is maintained) (Stacksche splint). She holds the end member in hyperextension so that the tendon ends can grow together again.

The after-treatment of extensor tendon injury is easier than with injured flexor tendons. It is usually sufficient to restrain the injured part of the body in a splint for six weeks. Subsequently, the patient can strain the tendon again and increase the load quickly.

Quadriceps tendon rupture / patellar tendon

A good treatment result for a quadriceps tendon rupture and a patellar tendon rupture can only be achieved through surgery.

The cure usually takes six to eight weeks. During this time, the knee should not be overly bent. This is ensured by a plaster sleeve or special rail.

An incomplete rupture can sometimes be dispensed with surgery. Instead, the leg must be relieved for six weeks. A splint prevents the leg from being completely bent.

Tendon tear: Disease course and prognosis

In most cases, a tendon rupture can be treated so well that the majority of those affected can easily cope with everyday life. However, the exact prognosis depends on the type of tendon tear and the type of treatment.

Many tendon injuries work well. However, if additional soft tissue or bone damage is present or the treatment is started late, the treatment is often more difficult. However, complications such as bleeding, infections or wound healing disorders are rare.

After the operation of flexor tendon injuries on the hand, the affected tendon can stick in the tendon sheath, which can lead to a permanent restriction of movement. Then a renewed intervention is necessary. Tendon shortening after surgery can also cause problems.

After the operation, you should begin physiotherapeutic exercises early and in a controlled manner. On the other hand, a sporty load should be maintained for several weeks or even up to one year for a quadriceps tendon rupture.

Other tendon tears such as extensor tendon injuries of the hand heal well without surgery. In extensor tendon injuries of the hand good results are achieved by the installation of the so-called stacked rail. However, a stretch deficit of about ten degrees remains more frequent.

In most cases, one has Sehnenriss a good prognosis. For example, even a pianist can often fully exercise his or her job following a flexor tendon injury.