Achilles tendon rupture - Revision history

Hoxbox: /* Management */

2020-03-24T13:17:25Z

Management

← Older revision		Revision as of 13:17, 24 March 2020
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	*Non-weightbearing		*Non-weightbearing
	*[[Short leg posterior splint]] with ankle slightly plantar-flexed		*[[Short leg posterior splint]] with ankle slightly plantar-flexed
			**Walking boot can be used as well <ref>Cast or Walking Boot for Achilles Tendon Rupture? https://journalfeed.org/article-a-day/2020/cast-or-weight-bearing-brace-for-non-op-achilles-tendon-rupture</ref><ref>Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448. doi: 10.1016/S0140-6736(19)32942-3. https://www.ncbi.nlm.nih.gov/pubmed/32035553?dopt=AbstractPlus</ref>

	==Disposition==		==Disposition==

2019-06-08T15:12:35Z

Background

← Older revision		Revision as of 15:12, 8 June 2019
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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 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

2019-06-08T15:11:08Z

Management

← Older revision		Revision as of 15:11, 8 June 2019
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	*Rest, ice, elevation		*Rest, ice, elevation
	*Non-weightbearing		*Non-weightbearing
	*[[Short leg posterior splint]] with ankle slightly ~~plantarflexed~~		*[[Short leg posterior splint]] with ankle slightly plantar-flexed

	==Disposition==		==Disposition==

2019-06-08T15:10:48Z

Evaluation

← Older revision		Revision as of 15:10, 8 June 2019
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	==Evaluation==		==Evaluation==
			===Workup===
	[[File:Achillessehnenruptur Sono.jpg\|thumb\|Achilles tendon rupture. No fracture on radiograph (left) with discontinuity of tendon over several centimeters (right; red line).]]		[[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>]]		[[File:Achilles Tendon Rupture Butterfield.gif\|thumbnail\|Ultrasound of achilles tendon rupture, long axis view<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]
	*~~Clinical diagnosis~~		*Consider x-rays to rule out fracture
	**[[Ultrasound: Tendons\|~~Ultrasound can be used~~ in equivocal cases]]		*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

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

			===Diagnosis===
			*Typically a clinical diagnosis (via positive Thompson test)

	==Management==		==Management==

2019-06-08T15:08:34Z

Thompson test

← Older revision		Revision as of 15:08, 8 June 2019
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	===Thompson test===		===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.]]		[[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%)''		''(SN 96% and SP 93%)''
	*Lay patient prone with knee bent at 90°		*Lay patient prone with knee bent at 90°

2019-06-08T15:08:20Z

Thompson test

← Older revision		Revision as of 15:08, 8 June 2019
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	===Thompson test===		===Thompson test===
	[[File:Rupture tendon achiléen.jpg\|Positive Thompson test for left Achilles tendon rupture: no movement of the foot despite the calf being squeezed.]]		[[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%)''		''(SN 96% and SP 93%)''
	*Lay patient prone with knee bent at 90°		*Lay patient prone with knee bent at 90°

2019-06-08T15:08:09Z

Thompson test

← Older revision		Revision as of 15:08, 8 June 2019
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	===Thompson test===		===Thompson test===
			[[File:Rupture tendon achiléen.jpg\|Positive Thompson test for left Achilles tendon rupture: no movement of the foot despite the calf being squeezed.]]
	''(SN 96% and SP 93%)''		''(SN 96% and SP 93%)''
	*Lay patient prone with knee bent at 90°		*Lay patient prone with knee bent at 90°

2019-06-08T15:06:18Z

Evaluation

← Older revision		Revision as of 15:06, 8 June 2019
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	==Evaluation==		==Evaluation==
			[[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>]]		[[File:Achilles Tendon Rupture Butterfield.gif\|thumbnail\|Ultrasound of achilles tendon rupture, long axis view<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]
	~~[[File:Achillessehnenruptur Sono.jpg\|thumb\|Achilles tendon rupture. No fracture on radiograph (left) with discontinuity of tendon over several centimeters (right; red line).]]~~
	*Clinical diagnosis		*Clinical diagnosis
	**[[Ultrasound: Tendons\|Ultrasound can be used in equivocal cases]]		**[[Ultrasound: Tendons\|Ultrasound can be used in equivocal cases]]

2019-06-08T15:06:00Z

Evaluation

← Older revision		Revision as of 15:06, 8 June 2019
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	==Evaluation==		==Evaluation==
	[[File:Achilles Tendon Rupture Butterfield.gif\|thumbnail\|Ultrasound of achilles tendon rupture, long axis view<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]		[[File:Achilles Tendon Rupture Butterfield.gif\|thumbnail\|Ultrasound of achilles tendon rupture, long axis view<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]
	[[File:Achillessehnenruptur Sono.jpg\|thumb\|Achilles tendon rupture ~~seen~~ on ~~ultrasound. Note~~ discontinuity over several centimeters (red line).]]		[[File:Achillessehnenruptur Sono.jpg\|thumb\|Achilles tendon rupture. No fracture on radiograph (left) with discontinuity of tendon over several centimeters (right; red line).]]
	*Clinical diagnosis		*Clinical diagnosis
	**[[Ultrasound: Tendons\|Ultrasound can be used in equivocal cases]]		**[[Ultrasound: Tendons\|Ultrasound can be used in equivocal cases]]

2019-06-08T15:04:49Z

Evaluation

← Older revision		Revision as of 15:04, 8 June 2019
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	==Evaluation==		==Evaluation==
	[[File:Achilles Tendon Rupture Butterfield.gif\|thumbnail\|Ultrasound of achilles tendon rupture, long axis view<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]		[[File:Achilles Tendon Rupture Butterfield.gif\|thumbnail\|Ultrasound of achilles tendon rupture, long axis view<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]
			[[File:Achillessehnenruptur Sono.jpg\|thumb\|Achilles tendon rupture seen on ultrasound. Note discontinuity over several centimeters (red line).]]
	*Clinical diagnosis		*Clinical diagnosis
	**[[Ultrasound: Tendons\|Ultrasound can be used in equivocal cases]]		**[[Ultrasound: Tendons\|Ultrasound can be used in equivocal cases]]