Muscle, Joint, and Shoulder Injuries

[Eric3237]

Yeah I think that's the best plan. How did you hurt it, btw?

I sprained my wrist not too long ago and didn't have too much problem getting it back up to snuff. Depending on what the doctor says, if it's a sprain, you'll want some type of active rehab. At this point if you are feeling "massive" pain, then it's questionable whether you should do anything. After the initial sharpest pain is gone you have to stretch the wrist and when the stretching can be done with little to no pain you can do wirst exercises and grip exercises to begin strengthening it.

[TALO]

Ruptured Tendon Overview

A tendon is the fibrous tissue that attaches muscle to bone in the human body. The forces applied to a tendon may be more than 5 times your body weight. In some rare instances, tendons can snap or rupture. Conditions that make a rupture more likely include the injection of steroids into a tendon, certain diseases (such as gout or hyperparathyroidism), and having type O blood.

Although fairly uncommon, a tendon rupture can be a serious problem and may result in excruciating pain and permanent disability if untreated. Each type of tendon rupture has its own signs and symptoms and can be treated either surgically or medically depending on the severity of the rupture and the confidence of the surgeon.

The 4 most common areas of tendon rupture are as follows:

Quadriceps

A group of 4 muscles, the vastus lateralis, vastus medialis, vastus intermedius, and the rectus femoris, come together just above your kneecap (patella) to form the patellar tendon.

Often called the quads, this group of muscles is used to extend the leg at the knee and aids in walking, running, and jumping.

Achilles

This tendon is located on the back (posterior) portion of the foot just above the heel. It is the site of attachment of the calf muscle (gastrocnemius muscle) to the heel of the foot (the calcaneus bone).


This tendon is vital for pushing off with the foot (this motion is known as plantarflexion). The Achilles helps you stand on your tiptoes and push off when starting a foot race.


Rotator cuff


Your rotator cuff is located in the shoulder and is actually composed of 4 muscles: the supraspinatus (the most common tendon ruptured), infraspinatus, teres minor, and subscapularis.


This group of muscles functions to raise your arm out to the side, helps you rotate the arm, and keeps your shoulder from popping out of its socket.


The rotator cuff tendon is one of the most common areas in the body affected by tendon injury. Some studies of people after death have shown that 8-20% have rotator cuff tears.

Biceps

The biceps muscle of the arm functions as a flexor of the elbow. This muscle brings the hand toward the shoulder by bending at the elbow.

Ruptures of the biceps are classified into proximal (close) and distal (far) types. Distal ruptures are extremely rare. The proximal rupture is at the attachment of the biceps at the top of your shoulder.

[TALO]

Ruptured Tendon Symptoms

An injury that is associated with the following signs or symptoms may be a tendon rupture.


A snap or pop you hear or feel


Severe pain


Rapid or immediate bruising


Marked weakness


Inability to use the affected arm or leg


Inability to move the area involved


Inability to bear weight


Deformity of the area


Symptoms associated with specific injuries


Achilles tendon rupture: You will be unable to support yourself on your tiptoes on the affected leg (you may be able to flex your toes downward because supporting muscles are intact).


Rotator cuff rupture: You will be unable to bring your arm out to the side.


Biceps tendon rupture: You will have decreased strength of elbow flexion and decreased ability to raise the arm out to the side when the hand is turned palm up.

[TALO]

When to Seek Medical Care

Call a doctor if you hear or feel a snap or pop, have severe pain, rapid or immediate bruising after an accident, and are unable to use the affected arm or leg. You may have a tendon rupture.

Visit the hospital’s emergency department whenever an injury occurs that produces severe pain and is accompanied by a pop or snap. Weakness, inability to move the area involved, inability to bear weight, and deformity of the area are other key symptoms that require a visit to the emergency department.

Because you know your body the best, if something appears to be serious to you, it is usually the best course to be conservative and have an evaluation.

Exams and Tests

Tendon rupture is usually diagnosed using a physical examination. Any imaging is done to confirm the diagnosis and decide the severity of the rupture.

Quadriceps

X-rays often show that your patella (kneecap) is lower than its normal position on a side view of the knee.

Using an MRI, your doctor can tell whether your rupture is partial or complete.

Achilles tendon

Your doctor may do a Thompson test. In this test, your doctor will have you kneel on a chair and dangle your foot over the edge. The doctor will then squeeze your calf in a particular place. If the toes on your foot don’t point downward when the doctor squeezes, then you probably have a ruptured Achilles tendon.

In a test called the blood pressure cuff test, your doctor will place a blood pressure cuff on your calf. The cuff is then inflated to 100 mm Hg. The doctor will then move your foot into a toes-up position. If your tendon is intact, it will cause the pressure to rise to about 140 mm Hg. If you have a tendon rupture, the pressure will increase only a small amount.

You may be able to flex your foot downward because your supporting muscles are intact. You will be unable to support yourself on your tiptoes on the affected side however.

X-rays taken from the side may show darkening of the triangular fatty tissue-filled space in front of the Achilles tendon or a thickening of the tendon.

MRI or ultrasound may be used to decide how severe your rupture is, although these tests are usually not needed to make the diagnosis.

Rotator cuff

You will be unable to initiate bringing your arm out to the side.

Your doctor may do a drop arm test. In this test, your arm is passively raised to 90°, and you are asked to hold your arm at this position. If you have rotator cuff rupture, slight pressure on the forearm will cause you to suddenly drop the arm.

X-rays may show that the long bone in your upper arm (the humerus) is slightly out of place.

Shoulder arthrography is most helpful in identifying a suspected rotator cuff tear. In this test, a dye that shows up on x-rays is injected directly into the shoulder joint, and the joint is then moved around. Then an x-ray of the shoulder is taken. If any dye is seen leaking from the joint, then it is highly likely that you have a ruptured rotator cuff.

MRI provides a noninvasive means of assessing the integrity of the rotator cuff although it is more costly and not as specific as arthrography.

Biceps

X-rays may show that your upper arm bone is out of place or that the place where the muscle attaches has changed.


If your biceps tendon is completely ruptured, the biceps retracts toward the elbow causing a swelling just above the crease in your arm. This is called the Popeye deformity.

You will experience decreased strength of elbow flexion and arm supination (moving the hand palm up).

You will have decreased ability to raise the arm out to the side when the hand is turned palm up.

[TALO]

Surgery

Quadriceps


Unless the doctor is sure that the injury is a partial tear, surgery will be done to repair the tendon.


After your operation, you will be placed in a cast or immobilizer as if you had a partial tear.


With physical therapy, your injured leg should be up to speed with your noninjured leg in 6 months.


Achilles tendon


Surgery to repair your 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 rerupture rate of the tendon.


After your operation, your foot will be immobilized with your toes pointing downward for 3-4 weeks and then progressively brought into neutral position over 2-3 weeks before weightbearing is started. Surgery carries with it a higher risk of infection than closed treatment.


Rotator cuff


Many surgeons will not attempt surgical repair until nonoperative 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


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 supination strength in their line of work.


You should leave your arm in a sling for a few days after surgery and then begin to use the affected arm as tolerated. After surgery, your elbow flexion and arm supination is near normal in about 12 weeks.

[TALO]

Prevention

To prevent future tears, avoid the cause of the ruptured tendon or treat the problem that led to the tear.

The prognosis for both surgery and nonsurgical treatment varies with the location and severity of the rupture.

Surgical repair, in concert with additional physical therapy, can result in return to normal strength. Nonoperative repair has also shown promise in tendon ruptures.

Nonoperative treatment is most effective in partial tendon ruptures. The drawback of nonoperative treatment is that strength is not as reliably returned to baseline with this type of treatment. The benefits include a decreased risk of infection and generally shorter recovery time.

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Author: Samuel J Haraldson, MD, Sports Medicine Fellow, Department of Sports Medicine, UT Southwestern/Methodist Charlton Hospital.

Coauthor(s): Barbara J Blasko, MD, Clinical Assistant Professor, Department of Emergency Medicine, University of California at Irvine College of Medicine.

Editors: Michael D Burg, MD, Assistant Clinical Professor, Department of Emergency Medicine, University Medical Center, University of California at San Francisco-Fresno; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Thomas Rebbecchi, MD, FAAEM, Program Director, Assistant Professor, Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey.

[Eric3237]

Thanks for the post. Most of the basic definitions, symptoms, first aid, etc. were covered in the first post. So if you get an injury look there to learn what the first things to look for and to do are in order to get the best outcome. That said, thanks for the addtional info, TALO.

[TALO]

Originally Posted by Eric3237

Thanks for the post. Most of the basic definitions, symptoms, first aid, etc. were covered in the first post. So if you get an injury look there to learn what the first things to look for and to do are in order to get the best outcome. That said, thanks for the addtional info, TALO.

We can always get a mod to delete what I posted....

[Eric3237]

NO NO, that's not what I meant. It's good info. I just want to make sure that someone new coming in that might click on the last page knows where to find the basic first aid stuff. Those initial moments and hours are SO crucial. And these are things you should begin even BEFORE you go to the doctor to minimize further injury. I.E. even if you have an apparent severe injury based on the symptoms listed and it is time to visit the emergency room, it would probably behoove you to do some basic first aid. In other words while you're sitting in the emergency room you should have an ice bag with you and have the area immobilized if necessary, etc.

This is great info on what a doctor will do and what to expect, etc. I just want people to know that they themselves are the first line of defense. And what you do and don't do can make a big difference in what the doctor finds when you see them.

For instance, much of this is speaking of acute severe injuries. But you can have a very minor injury with very little discomfort and REACT WRONGLY to turn it into something major. So those symptoms listed may not be there when you initially injury an area. But failing to recognize what IS there leads to that more severe injury and manifestations of those severe symptoms. And I suspect that this is actually what leads to most bad injuries in the gym so it is very important.

[TALO]

No worries Eric, I know you would never intend anything bad...I never took it like that either, just thought I would through it out there (to delete if already on board)....but I guess there can never be to much info on injuries....And sometimes I think it helps people look when the thread hasn't been visited in while.....