Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Tendon rupture is usually diagnosed using a physical examination. Any imaging is done to confirm the diagnosis and decide the severity of the rupture.
X-rays often show that
the 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.
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 determine the severity of the rupture, although these tests are usually not needed to make the diagnosis.
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
degrees, 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.
X-rays may show that your upper arm bone is out of place or that the site of muscle attachment 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.