Achilles tendon rupture: Difference between revisions

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==Background==
==Background==
[[File:Achilles-tendon.jpg|thumb|Achilles tendon anatomy.]]
*Most frequently ruptures 2-6cm above calcaneus (where blood supply is weakest)
*Most frequently ruptures 2-6cm above calcaneus (where blood supply is weakest)
*Typical pt 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
*[[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>
 
==Differential Diagnosis==
{{Calf pain DDX}}


==Clinical Features==
==Clinical Features==
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*Palpable defect in Achilles tendon 2-6cm proximal to calcaneus (SN 73% and SP 89% for partial tear)
*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
*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 pt prone w/ knee bent at 90'
**In normal pt, squeezing calf results in plantarflexion


[[File:Achilles tendon rupture.jpg|thumb|Ultrasound of Achilles tendon rupture, discontinuity shown by red bar. Plain film shows no fracture or avulsion.]]
==Differential Diagnosis==
{{Calf pain DDX}}


==Work Up==
==Evaluation==
*Clinical diagnosis
===Workup===
**[[Ultrasound: Tendons|Ultrasound can be used in equivocal cases]]
[[File:Achillessehnenruptur Sono.jpg|thumb|Achilles tendon rupture. No fracture on radiograph (left) with discontinuity of tendon over several centimeters (right; red line).]]
[[File:Achilles Tendon Rupture Butterfield.gif|thumbnail|Ultrasound of achilles tendon rupture, long axis view<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]
*Consider x-rays to rule out fracture
*Consider [[Ultrasound: Tendons|ultrasound in equivocal cases]]
**Comparing to normal ankle can reveal smaller defects or tears
**Comparing to normal ankle can reveal smaller defects or tears


==Treatment==
===Thompson test===
[[File:Rupture tendon achiléen.jpg|thumb|Positive Thompson test for left Achilles tendon rupture: no movement of the foot despite the calf being squeezed.]]
''(SN 96% and SP 93%)''
*Lay patient prone with knee bent at 90°
*In normal patient, squeezing calf results in plantar-flexion
 
===Diagnosis===
*Typically a clinical diagnosis (via positive Thompson test)
 
==Management==
*Rest, ice, elevation
*Rest, ice, elevation
*Non-weightbearing
*Non-weightbearing
*Short leg posterior splint w/ ankle slightly plantarflexed
*[[Short leg posterior splint]] with ankle slightly plantar-flexed
*Ortho referral


==Source==
==Disposition==
*Outpatient with ortho referral


*Uptodate
==References==
<references/>


[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Sports Medicine]]

Revision as of 15:12, 8 June 2019

Background

Achilles tendon anatomy.
  • 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
  • Quinolone-associated 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

Differential Diagnosis

Calf pain

Evaluation

Workup

Achilles tendon rupture. No fracture on radiograph (left) with discontinuity of tendon over several centimeters (right; red line).
Ultrasound of achilles tendon rupture, long axis view[2]

Thompson test

Positive Thompson test for left Achilles tendon rupture: no movement of the foot despite the calf being squeezed.

(SN 96% and SP 93%)

  • Lay patient prone with knee bent at 90°
  • In normal patient, squeezing calf results in plantar-flexion

Diagnosis

  • Typically a clinical diagnosis (via positive Thompson test)

Management

Disposition

  • Outpatient with ortho referral

References

  1. Seeger, et al, "Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population." PMID: 16456878
  2. http://www.thepocusatlas.com/musculoskeletal/