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Achilles Tendon Rupture: Exam Findings


- 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)

The needle test for complete rupture of the Achilles tendon.

Technical Tip: Hyperdorsiflexion sign in tears of the tendo achilles.

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