Achilles tendon rupture: Difference between revisions
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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 | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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**[[Ultrasound: Tendons|Ultrasound can be used in equivocal cases]] | **[[Ultrasound: Tendons|Ultrasound can be used in equivocal cases]] | ||
**Comparing to normal ankle can reveal smaller defects or tears | **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 pt, squeezing calf results in plantar-flexion | |||
==Management== | ==Management== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 19:45, 20 March 2017
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
- Clinical diagnosis
- Ultrasound can be used 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 pt, squeezing calf results in plantar-flexion
Management
- Rest, ice, elevation
- Non-weightbearing
- Short leg posterior splint with ankle slightly plantarflexed
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