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 | *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 | **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
- Achilles tendon rupture
- Calcaneal bursitis
- Cellulitis
- Compartment syndrome
- Deep venous thrombosis (DVT)
- Distal leg fractures
- Gastrocnemius strain
- Ruptured popliteal cyst (Bakers cyst)
- Superficial thrombophlebitis
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
Work Up
- Clinical diagnosis
- Ultrasound can be used in equivocal cases
- Comparing to normal ankle can reveal smaller defects or tears
Treatment
- Rest, ice, elevation
- Non-weightbearing
- Short leg posterior splint w/ ankle slightly plantarflexed
- Ortho referral
References
- Uptodate