Achilles Tendon Rupture
OVERVIEW
MOI
- The injury is a partial or full tear in the achilles tendon
- Complete ruptures tend to occur more in middle-age patients w/o pre-existing complaints
- Partial ruptures occur in well-trained athletes and typically involve the lateral aspect of the tendon
- Most Achilles tendon ruptures occur approximately 2 to 6 cm proximal to its insertion on the calcaneus
- Steroid injections and use of glucocorticoid use have been shown to increase rupture risk
MOI
- Commonly occur when pushing off with the weightbearing foot while extending the knee,
- Also, can occur from sudden or violent dorsiflexion of a plantarflexed foot (eccentric contracture)
SIGNS AND SYMPTOMS
- Sharp pain and a pop heard at the time of complete rupture is common
- Patients often describe a sensation of being kicked in the Achilles tendon
- Most have an immediate inability to bear weight or return to activity
- A palpable defect may be present in the tendon initially
- Positive Thompson Squeeze Test
- A large hematoma may be present in a complete rupture which can make it difficult to accurately examine.
- Partial rupture is associated with an acutely tender, localized swelling that occasionally involves an area of modularity
- Partial ruptures are difficult to accurately diagnose, and MRI should be used to confirm the diagnosis
TESTS
Thompson Squeeze Test
Thompson Squeeze Test
- The patient is placed prone, with both feet extended off the end of the table. Both calf muscles are squeezed by the examiner. If the tendon is intact, the foot will plantarflex when the calf is squeezed. If the tendon is ruptured, normal plantarflexion will not occur (a positive Thompson test).
- A false-negative Thompson test result can occur because of plantarflexion of the ankle caused by extrinsic foot flexors when the accessory ankle flexors are squeezed together with the contents at the superficial posterior leg compartment. It is important to critically compare the test with results in the normal side.
References:
- Brotzman S, Manske R, Daugherty K. Clinical Orthopaedic Rehabilitation An Evidence-Based Approach / S. Brent Brotzman, Robert C. Manske ; Managing Editor, Kay Daugherty [e-book]. Philadelphia, PA : Elsevier Mosby, c2011.; 2011. Available from: Library Catalog-Arizona, Ipswich, MA. Accessed July 3, 2014.
Last Edited by: Jason Greenwood , SPT at AT Still University on July 10, 2014