Treatment.—­The ends are approximated by placing the limb in an attitude which relaxes the muscle, and the position is maintained by bandages, splints, or special apparatus.  When it is impossible thus to approximate the ends satisfactorily, the muscle or tendon is exposed by incision, and the ends brought into accurate contact by catgut sutures.  This operation of primary suture yields the most satisfactory results, and is most successful when it is done within five or six days of the accident.  Secondary suture after an interval of months is rendered difficult by the retraction of the ends and by their adhesion to adjacent structures.

Rupture of the biceps of the arm may involve the long or the short head, or the belly of the muscle.  Most interest attaches to rupture of the long tendon of origin.  There is pain and tenderness in front of the upper end of the humerus, the patient is unable to abduct or to elevate the arm, and he may be unable to flex the elbow when the forearm is supinated.  The long axis of the muscle, instead of being parallel with the humerus, inclines downwards and outwards.  When the patient is asked to contract the muscle, its belly is seen to be drawn towards the elbow.

The adductor longus may be ruptured, or torn from the pubes, by a violent effort to adduct the limb.  A swelling forms in the upper and medial part of the thigh, which becomes smaller and harder when the muscle is thrown into contraction.

The quadriceps femoris is usually ruptured close to its insertion into the patella, in the attempt to avoid falling backwards.  The injury is sometimes bilateral.  The injured limb is rendered useless for progression, as it suddenly gives way whenever the knee is flexed.  Treatment is conducted on the same lines as in transverse fracture of the patella; in the majority of cases the continuity of the quadriceps should be re-established by suture within five or six days of the accident.

The tendo calcaneus (Achillis) is comparatively easily ruptured, and the symptoms are sometimes so slight that the nature of the injury may be overlooked.  The limb should be put up with the knee flexed and the toes pointed.  This may be effected by attaching one end of an elastic band to the heel of a slipper, and securing the other to the lower third of the thigh.  If this is not sufficient to bring the ends into apposition they should be approximated by an open operation.

The plantaris is not infrequently ruptured from trivial causes, such as a sudden movement in boxing, tennis, or hockey.  A sharp stinging pain like the stroke of a whip is felt in the calf; there is marked tenderness at the seat of rupture, and the patient is unable to raise the heel without pain.  The injury is of little importance, and if the patient does not raise the heel from the ground in walking, it is recovered from in a couple of weeks or so, without it being necessary to lay him up.