Achilles tendon rupture
Revision as of 17:52, 29 December 2014 by Neil.m.young (talk | contribs) (Additional SN and SP, changes in treatment)
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