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Achilles Tendon Rupture: Exam Findings

  • note that active plantarflexion may occur due to activity of tibialis posterior, peroneals, and long toe flexors;
  • diagnosis is clinched w/ one of two tests;

hyper-dorsiflexion sign

  • the patient is placed in the prone position, and the knees are flexed to 90 deg;
  • the examiner then passively dorsiflexes both feet maximally and compares the injured to the non injured side;

Thompson Test

  • have the patient prone w/ both feet extending past end of examing table;
  • calf muscles on the affected side are squeezed by the examiner;
  • if tendon is intact, the foot will plantar flex, & conversely if tendon is ruptured, the foot will not contract;
  • this text may lose accuracy after one week from injury;

O'brien's needle test

  • 25 gauge needle is inserted at right angle thru skin of calf muscle just medial to midline at point 10 cm proximal to superior border of calcaneus;
    • needle tip should be just w/ in substance of the tendo calcaneus;
  • motion of the hub of the needle in a direction opposite that of the tendon during passive dorsiflexion and plantarflexion of the foot confirms an intact tendon distal to the level of needle insertion;

location of tear

  • palpate tendon for site of maximal tenderness and fullness;
  • usually tears occur 2-3 cm above the calcaneal insertion;

estimate size of defect

  • a large defect may have a worse prognosis w/ non operative treatment (as compared to a rupture w/ a small defect)