Achilles tendon rupture: Difference between revisions

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==Background==
==Background==
*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


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*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%)
*Thompson test (SN 96% and SP 93%)
**Lay pt prone w/ knee bent at 90'
**Lay patient prone w/ knee bent at 90'
**In normal pt, squeezing calf results in plantarflexion
**In normal pt, squeezing calf results in plantarflexion



Revision as of 15:37, 2 July 2016

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
  • Quinolone associated rupture occurs in only 12 per 100,000 treatment episodes

Differential Diagnosis

Calf pain

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 w/ knee bent at 90'
    • In normal pt, squeezing calf results in plantarflexion
Ultrasound of Achilles tendon rupture, discontinuity shown by red bar. Plain film shows no fracture or avulsion.

Work Up

Treatment

  • Rest, ice, elevation
  • Non-weightbearing
  • Short leg posterior splint w/ ankle slightly plantarflexed
  • Ortho referral

References


  • Uptodate