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9/7/2018 0 Comments

Achilles Tendon Injury


Background:
  • Associated with fluoroquinolone use
  • Sudden, severe pain typically with rapid acceleration or pivoting. Sports like football, track and field (sprinting), basketball, soccer
  • May hear a "pop"
  • Inability to run, stand on toes, or climb stairs
  • Most frequently ruptures 2-6cm above calcaneus (where blood supply is weakest)
 
Dx:
  • Clinical diagnosis
  • Ultrasound can be used in equivocal cases:
    • Use linear probe (high frequency probe)
    • Place probe in longitudinal plane over suspect tendon:
    • Achilles 2-6cm above calcaneus
    • Fan and slide side to side to optimize your view
    • Slide distal to proximal to find defect
    • Turn probe 90° to assess for tendon body defects
    • Positive Findings
      • Discontinuity in longitudinal view of ligament
      • Collection of fluid in longitudinal or transverse view suggests injury
    • Look at other limb for "normal" anatomy
    • Have patient range attempt plantar/dorsi-flexion and view in real time
    • Be aware of partial tears!
  • Comparing to normal ankle can reveal smaller defects or tears
    • Kankle
  • Thompson test (SN 96% and SP 93%)
    • Lay patient prone with knee bent at 90°
    • In normal patient, squeezing calf results in plantar-flexion; Patient’s with tendon rupture will likely have lack of plantar flexion with calf squeeze
  • Palpable defect in Achilles tendon 2-6 cm proximal to calcaneus, however the data on this finding isn’t very strong and wouldn’t base your diagnosis solely on this fact
 
Tx:
  • Short leg posterior splint in plantarflexion
  • ~25% of ruptures will have some amount of active plantar flexion or be able to walk
  • Even if partial tear, splint! Can evolve into a complete tear
  • Outpatient orthopedic referral 
 
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