Achilles tendon rupture: Difference between revisions
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Neil.m.young (talk | contribs) (Additional SN and SP, changes in treatment) |
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**Lay pt prone w/ knee bent at 90' | **Lay pt prone w/ knee bent at 90' | ||
**In normal pt, squeezing calf results in plantarflexion | **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== | ==Treatment== | ||
*Short leg | *Rest, ice, elevation | ||
*Non-weightbearing | |||
*Short leg posterior splint w/ ankle slightly plantarflexed | |||
*Ortho referral | *Ortho referral | ||
Revision as of 17:52, 29 December 2014
Background
- 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
- Quinolone associated rupture occurs in only 12 per 100,000 treatment episodes
DDX
- DVT
- Compartment Syndrome
- Gastrocnemius Strain
- Calcaneal bursitis
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 pt 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
Source
- Tintinalli