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 | *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> | |||
*[[ | |||
==Clinical Features== | ==Clinical Features== | ||
*Sudden, severe pain | *Sudden, severe pain typically with rapid acceleration or pivoting | ||
*May hear a "pop" | |||
*Inability to run, stand on toes, or climb stairs | *Inability to run, stand on toes, or climb stairs | ||
*Palpable | *Palpable defect in Achilles tendon 2-6cm proximal to calcaneus (SN 73% and SP 89% for partial tear) | ||
*Thompson test | *20-30% of ruptures will have some amount of active plantar flexion or be able to walk | ||
==Differential Diagnosis== | |||
{{Calf pain DDX}} | |||
==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: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 | |||
===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 | |||
*Non-weightbearing | |||
*[[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== | ||
* | *Outpatient with ortho referral | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
[[Category:Sports Medicine]] | |||
Latest revision as of 13:17, 24 March 2020
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, 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
- 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
Workup
Ultrasound of achilles tendon rupture, long axis view[2]
- Consider x-rays to rule out fracture
- Consider ultrasound in equivocal cases
- Comparing to normal ankle can reveal smaller defects or tears
Thompson test
(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
- Non-weightbearing
- Short leg posterior splint with ankle slightly plantar-flexed
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
- ↑ http://www.thepocusatlas.com/musculoskeletal/
- ↑ 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
- ↑ 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