In the muscle-tendon unit, the area where the muscle joins the tendon is often the weakest link in the chain. Consequently, this is often the location where acute ruptures (or complete tearing) of the tendon occur. The tendon, however, can also completely tear away from its bony attachment. In sport, ruptures of the Achilles tendon and biceps tendon are the most common tendon ruptures. Tendon ruptures often occur when quick, explosive actions are involved or after prolonged tendinitis where there were micro tears of the tendon.

Signs and Symptoms

• Loss of muscle function.
• Localized pain.
• Swelling may or may not be present.
• Deformity such as an indentation may or may not be present. The affected muscle will be bunched up in a contracted state.
• The athlete will usually report hearing a "snap" or "pop" sound at the time of injury. An athlete may complain that they were hit in the area.
• Site specific tests can be completed to determine the severity of tear, such as the calf muscle squeeze (Thompson test) for Achilles tendon rupture.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury (i.e. bracing). REST the area to promote healing. ICE the area to reduce inflammation. COMPRESSION is NOT recommended. ELEVATE the area to increase circulation towards the heart.

Medical Referral. In most cases surgical reattachment of the muscle is necessary.

Rehabilitation. After physician approval, see a physiotherapist for modalities, range of motion, and strengthening exercises.

Return to Activity. Only after complete healing with a physician's OK. If surgery is required, an exercise rehabilitation program can return the athlete to play only after a minimum of four months.

Prevention

• Adequate warm-up, ongoing strength and conditioning.
• Proper management of tendinitis can reduce the risk of complete tendon rupture.

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