Achilles tendon rupture: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Quinolone " to "Quinolone") |
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*Typical patient is 30-50yr old man who participates in strenuous activities on occasional basis | *Typical patient is 30-50yr old man who participates in strenuous activities on occasional basis | ||
*[[Quinolone]]associated rupture occurs in only 12 per 100,000 treatment episodes, and risk may be equivalent to oral steroids or non-quinolone antibiotics <ref>Seeger, et al, "Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population." PMID: 16456878 </ref> | *[[Quinolone]]associated rupture occurs in only 12 per 100,000 treatment episodes, and risk may be equivalent to oral steroids or non-quinolone antibiotics <ref>Seeger, et al, "Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population." PMID: 16456878 </ref> | ||
==Clinical Features== | ==Clinical Features== | ||
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**In normal pt, squeezing calf results in plantarflexion | **In normal pt, squeezing calf results in plantarflexion | ||
==Differential Diagnosis== | |||
{{Calf pain DDX}} | |||
==Evaluation== | |||
[[File:Achilles tendon rupture.jpg|thumb|Ultrasound of Achilles tendon rupture, discontinuity shown by red bar. Plain film shows no fracture or avulsion.]] | [[File:Achilles tendon rupture.jpg|thumb|Ultrasound of Achilles tendon rupture, discontinuity shown by red bar. Plain film shows no fracture or avulsion.]] | ||
*Clinical diagnosis | *Clinical diagnosis | ||
**[[Ultrasound: Tendons|Ultrasound can be used in equivocal cases]] | **[[Ultrasound: Tendons|Ultrasound can be used in equivocal cases]] | ||
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*Non-weightbearing | *Non-weightbearing | ||
*Short leg posterior splint with ankle slightly plantarflexed | *Short leg posterior splint with ankle slightly plantarflexed | ||
* | |||
==Disposition== | |||
*Outpatient with ortho referral | |||
==References== | ==References== | ||
Revision as of 18:10, 20 March 2017
Background
- Most frequently ruptures 2-6cm above calcaneus (where blood supply is weakest)
- Typical patient is 30-50yr old man who participates in strenuous activities on occasional basis
- Quinoloneassociated rupture occurs in only 12 per 100,000 treatment episodes, and risk may be equivalent to oral steroids or non-quinolone antibiotics [1]
Clinical Features
- Sudden, severe pain typically with rapid acceleration or pivoting
- May hear a "pop"
- Inability to run, stand on toes, or climb stairs
- Palpable defect in Achilles tendon 2-6cm proximal to calcaneus (SN 73% and SP 89% for partial tear)
- 20-30% of ruptures will have some amount of active plantar flexion or be able to walk
- Thompson test (SN 96% and SP 93%)
- Lay patient prone with knee bent at 90°
- In normal pt, squeezing calf results in plantarflexion
Differential Diagnosis
Calf pain
- Achilles tendon rupture
- Calcaneal bursitis
- Cellulitis
- Compartment syndrome
- Deep venous thrombosis (DVT)
- Distal leg fractures
- Gastrocnemius strain
- Ruptured popliteal cyst (Bakers cyst)
- Superficial thrombophlebitis
Evaluation
- Clinical diagnosis
- Ultrasound can be used in equivocal cases
- Comparing to normal ankle can reveal smaller defects or tears
Management
- Rest, ice, elevation
- Non-weightbearing
- Short leg posterior splint with ankle slightly plantarflexed
Disposition
- Outpatient with ortho referral
References
- ↑ Seeger, et al, "Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population." PMID: 16456878
- Uptodate