Is It Worse to Tear a Ligament or a Tendon?

Both ligaments and tendons are fibrous connective tissues that play roles in stabilizing and moving bones. Damage can occur with overuse or overstretching, and they can become weak and prone to injury due to aging. 

• Ligament: Connects two bones, one on each end, and holds them together to maintain the structure and stability of the joints. 
• Tendon: Connects muscle with bone, helps move the bone, and maintains structural integrity.

Quick diagnosis of any injury is crucial because treatment varies depending on the severity of the tear. Severe tears require surgical repair.

A ligament injury is often called a sprain. Sprains occur mostly due to overstretching, such as during a fall. These injuries may take weeks to months to heal. The most common sprains that are associated with falls:

• Ankle sprain due twisting the ankle, causing anterior cruciate ligament injury
• Thumb sprain due to hyperextension of the thumb, causing ulnar collateral ligament injury

Sprains are graded based on the extent of the ligament damage:

• First degree: Ligament is strained but not torn. When the damaged joint is subjected to a ligament stability test, the joint stays stable and the ligament remains tight.
• Second degree: Partial tear to the ligament results in instability of the joint. There may be pain and disability of the joint that needs immediate medical intervention.
• Third degree: Complete tear of the ligament and bone fracture may be present. This injury causes deformity, discoloration, swelling, joint sensitivity, and discomfort with movement. 

A tendon injury is often referred to as a strain. Strains result from overuse of the tendons caused by repetitive movements, leading to a tear. In most cases this type of injury is caused by several small tears in the tendon that have occurred over time. Tendon injuries may take weeks to months to heal.

The most commonly injured tendons are the Achilles tendon in the foot, quadriceps in the knee, biceps tendon in the elbow, and rotator cuff in the shoulder, because these are often overused. Sedentary habits can also cause you to become more susceptible to strains, as you may have developed muscular weakness as a result of inactivity.

Tendon injuries may involve:

• Tendinitis: Inflammation of the tendon that occurs mostly due to overuse or trauma. The affected region is painful, swollen, and warm to the touch.
• Tendinosis: Similar to a strain and commonly develops secondary to overuse, causing small rips in the tissue within and around the tendon.

Both the ligament and tendon injuries can cause pain, swelling, tenderness, and deformity. Physical examination and imaging tests can help your doctor make a diagnosis and differentiate between a ligament tear and a tendon tear.

Medical management

• Minor sprains and strains are treated with the rest, ice, compress, elevation (RICE) method.
• Pain may be managed with over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs. Physiotherapy may be advised in patients with chronic injuries.
• Tendon injuries may come with a risk of subluxation (separation from the joint), so patients are often advised to make lifestyle modifications to ensure that the tendon is free from excess pressure.

Surgical management

• Ligament tears may not require surgical intervention unless it is severely ruptured and has associated bone fracture.
• Each type of tendon tear has its unique set of symptoms and can be treated surgically or medically depending on the severity of the injury.
• Use of splints, braces, and casts are done to immobilize the ligament or tendon, which helps speed up recovery.