Anabolic Steroid Use and Ruptured Tendons
Tendon are the fibrous bands of tissue that attach the muscles to bones. Although they are remarkably sturdy – and can withstand forces of more than 5 times a person’s body weight – they can rupture.
The rotator cuff in the shoulder (the 4 muscles that work together to raise, extend and rotate the arm and the bicep are among the most common areas of tendon rupture in the body. And while tendon rupture is exceedingly rare, it is also extremely painful and can result in permanent disability if not treated promptly.
In this article experienced, board certified Detroit area hand and arm surgeon Dr. Uzma Rehman discusses the relationship between anabolic steroid use and ruptured tendons in the upper extremities.
Causes of Ruptured Tendons
Certain diseases such as gout or hyperparathyroidism, as well as having type O blood, increase the risk of tendon rupture. But the most common cause seems to be steroid use – both medicinally injected and when used by athletes to build muscle.
The 4 most common areas of tendon rupture include:
- Quadriceps – muscles above the knee
- Achilles tendon – on the back portion of the foot and ankle
- Biceps – the muscle on the upper arm
- Rotator cuff – where the arm meets the shoulder
Anabolic Steroid (AAS) Use and Ruptured Tendons
Responsible doctors always prescribe steroid usage conservatively and in moderation. This is because, while steroids offer many tremendous treatment options, overuse comes with a wide array of potentially dangerous side effects. So, the benefits must always be weighed against the risks.
Anabolic steroids are synthetically manufactured drugs that have many of the same effects on the body as the male hormone testosterone – including facilitating the ability to build muscle mass. Though anabolic steroids are a Class C drug and are supposed to be prescription-only, many athletes use them illegally to build muscle.
Weightlifters and bodybuilders in particular take them regularly to improve their physical performance and build up their bodies.
Many side effects of anabolic steroid use have been known for years: infertility, shrunken testicles, erectile dysfunction, baldness, male breast development and prostate cancer.
But new clinical studies have now also reported increased risk of tendon ruptures in men using anabolic-androgenic steroids (AAS). This was recently reported in Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study published by the United States National Library of Medicine in the National Center for Biotechnology Information
Symptoms of a Ruptured Tendon
A ruptured tendon in the hand or wrist typically announces itself with a distinctive set of symptoms that demand immediate attention. Most patients report a sudden, sharp pain at the moment of rupture, often accompanied by an audible “pop” or snapping sensation. This initial pain may subsequently transform into a more diffuse aching or throbbing that persists and intensifies with movement attempts.
Visual and functional changes quickly become apparent, with noticeable swelling, bruising, and sometimes a visible deformity where the tendon has retracted. One of the most telling signs is a new inability to perform previously routine movements – for instance, a ruptured flexor tendon in a finger results in the inability to bend that digit, while an extensor tendon rupture prevents straightening.
The location of symptoms offers important diagnostic clues about which specific tendon has been affected. Extensor tendon ruptures (on the back of the hand and fingers) typically create an inability to straighten the affected finger, resulting in a drooping appearance even when attempting extension. Flexor tendon ruptures (on the palm side) prevent finger bending and may cause pain in the palm or along the finger.
Thumb tendon ruptures create distinct functional deficits depending on which tendon is involved – the extensor pollicis longus (affecting thumb extension and positioning) or the flexor pollicis longus (affecting the ability to bend the thumb tip). Wrist tendon ruptures can cause pain, weakness, and restricted motion throughout the hand due to their role in controlling multiple digits simultaneously.
Dr. Rehman emphasizes that anabolic steroid use significantly increases the vulnerability of tendons to rupture, often causing them to fail under normal stresses that intact tendons would easily withstand. She notes that steroid-related ruptures frequently occur without significant trauma, sometimes during ordinary activities, and may affect multiple tendons either simultaneously or sequentially – a pattern rarely seen in non-steroid users. Additionally, these ruptures typically demonstrate poorer tissue quality during surgical repair, potentially complicating recovery compared to ruptures in patients without steroid exposure.
What to Do if You Have a Ruptured Tendon
If you suspect a tendon rupture in your hand or wrist, seeking immediate medical attention is crucial for preserving function and preventing permanent damage. Complete tendon ruptures do not heal independently and typically require surgical intervention, with timing representing a critical factor in recovery potential.
As a first response, apply the RICE protocol—Rest the affected area, apply Ice to reduce swelling, Compress with a soft bandage, and Elevate the hand above heart level. Avoid any attempts to “test” the injured area through movement, as this can worsen the injury and potentially complicate subsequent surgical repair by causing further tendon retraction.
During medical evaluation, it’s also essential to provide full disclosure to your healthcare providers about any history of anabolic steroid use, even if discontinued. Steroid-associated ruptures often come with poorer tissue quality and may require modified surgical approaches or augmentation techniques to achieve stable repair. Bringing all current medications and supplements to your appointment helps provide your surgeon with comprehensive information for optimal treatment planning. Dr. Rehman emphasizes that her practice prioritizes patient care over judgment, ensuring that those with steroid-related injuries receive appropriate treatment regardless of how the injury occurred.
Treating Tendon Rupture
Tendon ruptures can be treated either surgically or medically depending on the location of the rupture, the severity of the rupture, and the age of the patient. But, in all cases, it is a very painful condition that requires months of treatment and rehabilitation – and it can lead to long term immobility if not treated promptly and properly.
Following diagnosis, treatment for tendon ruptures most typically involves surgical repair to reconnect the severed ends, often followed by specialized hand therapy protocols. Dr. Rehman utilizes advanced surgical techniques tailored to each patient’s specific injury pattern and tissue quality. For patients with histories of anabolic steroid use, Dr. Rehman may implement enhanced repair techniques that account for potentially compromised tissue integrity.
The recovery process following tendon repair requires dedicated adherence to therapy protocols and activity restrictions, typically lasting several months before returning to full function. Patients with steroid-associated ruptures may require extended rehabilitation due to altered healing biology and potentially increased risk of re-rupture or complications. Throughout recovery, maintaining open communication with your surgical team about progress, concerns, and any new symptoms ensures optimal outcomes and allows for timely intervention if complications arise.
Top Detroit Hand & Arm Surgeon
The association between anabolic steroid use by athletes and bodybuilder and tendon rupture, is just one more very good reason that performance enhancing AAS drugs should be avoided.
If you are suffering from an injury or pain in your fingers, wrist, elbow or arm, contact board certified Detroit area hand and arm surgeon Doctor Rehman for a comprehensive evaluation and consultation. Early detection, and an aggressive treatment plan, is the most effective way to combat the effects of conditions like a ruptured tendon, and prevent long term damage and loss of mobility.
Doctor Rehman will assess your individual situation, and prescribe the treatments and therapies that are best for your condition.
