Localization in the hand

However, the individual localizations on the hand, i.e. on the respective fingers or thumb, are now important. The tendons of the extensor muscles on the fingers are particularly at risk during sports activities such as volleyball, handball and basketball. The tendons of the extensor muscles can tear at the 3 joint regions of the end joint, middle joint or base joint due to strong pressure and tensile loads, but also minor injuries.The individual ruptures of the tendons have different therapeutic indications; for example, a rupture of the tendon at the end of the finger joints, also known as “hammer finger”, is treated rather conservatively using a finger splint.

If, however, a torn tendon occurs in the area of the middle joint, surgery is required because the risk of permanent functional impairment is too high and the tendons cannot heal sufficiently by immobilization alone. The deformity resulting from a rupture of the tendons of the finger extensors in the middle joint is called “buttonhole deformity”. This results in a characteristic picture because the fingers in the end joint are stretched, but in the middle joint they can only be bent due to the torn tendon.

Lesions in the area of the base joint refer to the extensor cap in a few cases. This is the holding system of all tendons that pull across the base joint into the fingers. When strong external forces are applied, it is not so much a single tendon in the base joint that tears but rather the extensor cap.

Here, surgical treatment is unavoidable. Characteristically, a “snapping sound” can be heard when the fist is closed if the extensor cap is torn. The long thumb extensor tendon of the extensor pollicis longus muscle often ruptures at the thumb, making it impossible to stretch the distal joint.

Localization of lower extremities

There are also special locations on the lower extremity where the occurrence of a torn tendon is typical. Ruptures manifest themselves more directly at the transition from the lower leg to the foot. The first to be mentioned is the Achilles tendon (tendo calcaneus).

Because of its ability to withstand a tensile load of more than 1 t, it is the strongest tendon in our body. It is especially endangered during sports. Predisposed are sports like skiing, tennis and jogging.

If the Achilles tendon tears, a loud bang occurs, which can be compared to a whip blow. In addition, the tendon of the posterior tibialis muscle, a part of the deep calf muscles in the foot region, can be affected by a torn tendon. The muscle pulls from the back of the lower leg along the inner ankle towards the underside of the foot and is also responsible for flexion and supination in the foot.

However, a total tear is rather rare; in most cases, the tendons are torn lengthwise at most. Degenerative processes and overloading also play a more important role than acute trauma. For this reason, tendosynovitis, which is caused by overloading, overstretching and degeneration, is the primary cause of tendon lesion.

The consequences are swelling, pain and finally small longitudinal tears. The foot malposition “buckling foot” also increases the risk of tendosynovitis. With regard to the tendon of the tibialis posterior muscle, the clinical picture of “tibialis posterior dysfunction”, a degenerative change of the tendon at its attachment point resulting in loss of function, is more frequent and significant than a torn tendon.

Finally, the peroneal tendon of the M. peroneus longus, the long fibula muscle, should also be mentioned. In contrast to the tibialis posterior tendon, this tendon runs along the outer ankle. What the tendons have in common, however, is that here, too, a total tear is a less common injury.

An important disease is the so-called “Peroneal Tendon Split Syndrome”. In this syndrome, only a fine longitudinal tear of the tendon of the peroneus brevis muscle occurs in the area of the external ankle; the long peroneal tendon is not torn, but “drills” into the longitudinal tear from behind. It can therefore be said that there are several locations on the body where a ruptured tendon can manifest itself with varying degrees of severity and significance.

A torn tendon can also occur on the thigh. The tendon that connects the large thigh muscle (quadriceps) with the patella is mainly affected. Typically, this tendon ruptures in an impending fall when climbing stairs due to the jerky tension of the quadriceps muscle.

A rupture manifests itself with pain and swelling in the knee area. In addition, the extension in the knee joint is severely limited. The tendon rupture in the thigh is diagnosed by an ultrasound examination or an MRI. Therapeutically, a surgical suture of the tendon helps.