Lauren Warshaw, MS4
The Article: Odom, M., Haas, N., Phillips, K. “BEDSIDE ULTRASOUND DIAGNOSIS
OF COMPLETE ACHILLES TENDON TEAR IN A 25-YEAR-OLD MAN WITH CALF
INJURY”. The Journal of Emergency Medicine 2018; 524: 694-696.
The Idea: A 25 year-old man presented to the Emergency Department after his right
heel was stepped on from behind while his foot was planted the day prior. He was still
able to bear weight on his right foot. In the ED, there was swelling and ecchymosis of
the right posterior lower leg and a palpable tissue defect proximal to the calcaneus.
Physical exam was consistent with an Achilles tendon rupture. An ultrasound was
performed with a linear probe in the longitudinal plane, revealing an anechoic defect in
the distal Achilles tendon fibers.
The Takeaway: Despite the strength and size of the AT, it is one of the most commonly
injured tendons and the rate of rupture is increasing likely secondary to increased
participation in sports across a wider range of age groups. AT rupture occurs most often
with forceful plantar flexion or sudden dorsiflexion. Risk factors include systemic steroid
use, quinolone and auto immune or inflammatory disorders. Presentation includes
posterior leg pain often with a loud popping noise. Patients often cannot plantar flex or
toe walk. Ultrasound has been shown to be a viable imaging modality with a sensitivity
and specificity of 100% and 83% respectively. An anechoic defect that transects the
tendon is consistent with a full thickness tear. Other features include tendon retraction
and posterior acoustic shadowing. For treatment, surgical management is mainly used
for young patients or athletes. Given its availability, low cost, and lack of ionizing
radiation, point of care ultrasound should be utilized for Achilles rupture diagnosis.