Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
Send us all your questions or requests, and our expert team will assist you.
Diagnosing a tendon injury is a detective process that combines a hands-on physical exam with advanced technology. Because tendons are soft tissue, they do not show up on standard X-rays. This means doctors must rely on other methods to “see” the damage. Often, the diagnosis is clear from the moment the patient walks (or limps) into the room, but confirming the extent of the damage is crucial for planning the surgery.
A surgeon needs to know if the tendon is completely ruptured or just torn, how far the ends have pulled apart, and the quality of the remaining tissue. Is it healthy enough to hold stitches, or is it shredded like crabmeat? This section explains the diagnostic journey, from the simple tests done in the exam room to the high-tech scans that map out the surgical plan.
The diagnosis begins with listening to the patient. The description of a “pop” or the inability to perform a specific movement is often diagnostic on its own. The doctor will then perform a physical exam. They will inspect the area for swelling, bruising, and deformity. In a complete rupture, there is often a visible gap or dent where the tendon used to be.
Palpation (touching) allows the doctor to feel the defect in the tendon. They will also perform specific functional tests. For an Achilles rupture, the Thompson Test is the gold standard. The patient lies on their stomach, and the doctor squeezes the calf muscle. If the tendon is intact, the foot will point down. If the tendon is ruptured, the foot remains still. For rotator cuff tears, the doctor will move the arm in specific directions to isolate individual tendons and test for weakness.
Ultrasound is becoming the stethoscope of the orthopedic surgeon. It uses high-frequency sound waves to create real-time images of the tendon. It is painless, involves no radiation, and can be done right in the office.
The major advantage of ultrasound is that it is dynamic. The doctor can ask you to move your finger or foot while they are scanning. They can see the tendon gliding (or failing to glide) in real time. They can see the gap in a ruptured tendon open and close as the muscle contracts. This provides functional information that a static picture cannot. It is particularly excellent for diagnosing Achilles tendon issues and hand tendon injuries.
MRI is the most comprehensive tool for evaluating tendon injuries. It uses powerful magnets and radio waves to create detailed cross-sectional images of the soft tissues. Unlike ultrasound, which sees only the surface, MRI can see deep into the joint and bone.
An MRI provides a roadmap for surgery. It shows the exact location of the tear, the amount of retraction (how far the tendon has pulled back), and the health of the muscle. If the muscle has turned to fat (atrophy) from long-term disuse, surgery might not be successful. MRI also helps rule out other injuries, such as cartilage damage or ligament tears that might need to be fixed at the same time.
On an MRI, a healthy tendon looks like a dark, black strap. A tear appears as a bright white fluid-filled gap within that black strap.
The radiologist measures the size of this gap. This measurement helps the surgeon decide if they can pull the ends together directly or if they will need a graft or specialized lengthening procedures to bridge the distance.
MRI is excellent at distinguishing between acute inflammation (fluid) and chronic degeneration (scar tissue).
This helps set expectations. Acute injuries usually have better surgical outcomes. Chronic, degenerative tendons are harder to sew and heal more slowly, which the surgeon can discuss with the patient beforehand.
Even though X-rays do not show tendons, they are almost always the first test ordered. Why? This is due to the doctor’s need to rule out bone problems.
Sometimes, a tendon doesn’t snap in the middle; it pulls a chunk of bone off the attachment point. This is called an avulsion fracture. An avulsion fracture is treated differently than a tendon rupture; it involves fixing the bone, not just sewing the soft tissue. X-rays also show the shape of the bones. Bone spurs (sharp growths) can rub against tendons and cause tears (impingement). Identifying these spurs on X-rays tells the surgeon they need to be shaved down during surgery to prevent future damage.
In complex injuries, especially in the arm and hand, nerves are often damaged alongside tendons. If a patient has numbness or weakness that doesn’t make sense for a simple tendon injury, the doctor may order nerve conduction studies (EMG/NCS).
These tests measure the electrical signals traveling through the nerves. They can pinpoint exactly where a nerve is damaged and how severe it is. Knowing the status of the nerves is critical because a repaired tendon will not work if the muscle pulling it doesn’t receive signals from the brain.
To get the most out of your diagnostic visit, wear loose clothing that allows access to the injured area. Be prepared to describe the exact motion you were doing when the pain started.
If you have had previous surgeries or injections in that area, tell the doctor, as this changes the tissue quality. Bringing a list of your medications is also helpful, as some drugs affect healing and surgical planning.
Send us all your questions or requests, and our expert team will assist you.
No, an MRI is painless. However, the machine is loud and requires you to lie very still in a tight tube for 30-45 minutes. If you are claustrophobic, let your doctor know; they can prescribe a mild sedative or use an “open” MRI.
Often, yes, especially for superficial tendons like the Achilles. However, MRI is better for seeing deep structures (like inside the shoulder) and for assessing the overall health of the bone and muscle.
That is the Thompson Test. It is a mechanical check. Squeezing the muscle should mechanically pull the tendon and move the foot. If the foot doesn’t move, the mechanical link (the tendon) is broken.
Usually, no. A standard MRI is sufficient. However, if the doctor suspects a re-tear after a previous surgery, they might inject dye (arthrogram) to get a better view of the repair.
For suspected tendon ruptures, sooner is better. Diagnosis within the first week allows for the best surgical options. Waiting too long can make simple repairs impossible.
Your Comparison List (you must select at least 2 packages)
