Touching up torn tendons
PATIENT PRESENTATION:
Patient is a 42-year-old male with no significant past medical history presented to the Emergency Department regarding right calf pain since this morning. Patient states that the pain started while he was getting ready to run, notes that he heard a “popping” sound and experienced immediate pain in the distal portion of the right calf. He denies DE/PVT risk factors, numbness, tingling, inability to bear weight or any other outstanding symptoms.
Physical examination showed normal ROM, normal strength, tenderness to palpation of the right distal calf with minimal swelling and negative Thompson’s test.
A bedside point-of-care ultrasound (POCUS) was performed using a 13–6 MHz linear probe, correlating with the point of tenderness and area of visual deformity. The findings are found in Figure 1.
DIAGNOSIS:
Achilles tendon rupture accounts for roughly 20% of all large tendon ruptures (1). The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history present illness and physical examination. However, signs and symptoms of Achilles tendon rupture can be equivocal in the acute stage.
For instance, a false-negative Thompson test result, which examines the integrity of the Achilles tendon by squeezing the calf, can occur if plantar flexion is produced by intact foot flexors (2). As a result, approximately 20%-25% of acute ruptures can go undiagnosed initially (2-3). POCUS can be useful as a confirmatory test. It identifies effectively the location of a tear, gap between the torn ends of the tendon, and extensiveness of the rupture. (4).
X-ray images of ankle, tibia and fibula were obtained for our patient to rule out bony pathology. With x-ray images showing no acute process, the patient was immobilized in posterior short leg splint with foot in plantar flexion and discharged home with appropriate follow‐up with orthopedic specialist. Eventually his Achilles tendon was repaired surgically the following week without any complication.
REFERENCES:
- Gillies H, Chalmers J. The management of fresh ruptures of the tendon Achilles. J Bone Joint Surg Am. 1970;52(2):337–343.
- Park SH, Lee HS, Young KW, Seo SG. Treatment of Acute Achilles Tendon Rupture. Clin Orthop Surg. 2020;12(1):1-8. doi:10.4055/cios.2020.12.1.1
- Hartgerink P, Fessell D, Jacobson J, van Holsbeeck M. Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. 2001;220(2):406-412.
- Maffulli N, Dymond NP, Regine R. Surgical repair of ruptured Achilles tendon in sportsmen and sedentary patients: a longitudinal ultrasound assessment. Int J Sports Med. 1990;11(1):78–84.