OWL: OCOSH Classification/Trauma/Muscle Tendon Injuries/Heelcord Ruptures

2009 Achilles Tendon Injuries and Tendonitis eMedicine PMR

Saglimbeni & Fulmer — 2008-04-14 21:00:48 GMT

Achilles tendon rupture is a complete disruption of the Achilles tendon, observed most commonly in patients aged 30-50 years, usually occurring at a point 4-5 cm proximal to the calcaneus. This area above the calcaneus is the zone of poor blood flow in the tendon. Achilles tendonitis is inflammation of the tendon or paratenon, usually resulting from overuse associated with a change in playing surface, footwear, or intensity of an activity. Terminology used to describe this condition currently is subject to debate. Some evidence suggests that tendinopathy or tendinosis are better terms, as inflammation, suggested by the term tendonitis, may not play a key role in this process.
Synonyms and related keywords: Achilles tendon rupture, tendinopathy, tendinosis, Achilles overuse injuries
Saglimbeni & Fulmer 2007

2009 Clarification of the Simmonds�Thompson test for rupture of an Achilles tendon

Douglas et al — 2009-05-26 21:00:48 GMT

The Simmonds�Thompson test, described in 1957 and 1962, respectively, remains the principal clinical test for rupture of an Achilles tendon. However, there is some discrepancy in the literature regarding its mechanical significance. A positive test has been reported to indicate a complete rupture of the tendon, and the cited mechanical reason for the positive test (complete rupture) is the loss of integrity of the soleal part of the tendon. This is consistent with Thompson�s initial description, in which he reported that �... by anatomical dissections ... plantar flexion of the foot depends on an intact soleus muscle attachment to an intact tendon of Achilles.� O�Brien, however, reported that a negative test depended on an intact connection of the gastrocnemius aponeurosis to that of the soleus muscle and further described a needle test to assess this.
James Douglas, MD Michael Kelly, MB BS� Piotr Blachut, MD� Can J Surg, Vol. 52, No. 2, April 2009 E40 (full text)

Achilles Tendon Rupture A Challenging Diagnosis Medscape

Gravlee, Hatch & Galea — 2008-11-19 21:00:48 GMT

Since the 1950s the incidence of spontaneous complete rupture of the Achilles tendon has risen steadily, possibly as a result of increased sedentary lifestyles and intermittent participation in recreational sports.[1] Today the Achilles tendon is the second most frequently ruptured tendon,[2] and no other tendon suffers complete rupture more often.[3] Up to 25% of all cases are misdiagnosed,[4-6] with serious consequences for the patient.
J Am Board Fam Pract 13(5):371-373, 2000. Gravlee, Hatch & Galea

Achilles Tendon Rupture Clinical Case Challenge Medscape

Donald Johnson, MD, Moreno Morelli, MD — 2008-11-19 21:00:48 GMT

The differential diagnosis for ruptured Achilles tendon may not be readily forthcoming if edema exists and there are indifferent responses to various manual testing procedures. Ultrasonography may be needed to establish the diagnosis and to determine the apposition of the ruptured tendon ends. This case challenge highlights a patient typical of those presenting with Achilles rupture and provides a discussion of the factors involved in determining the differential diagnosis and selecting the appropriate therapy, individualized to the patient's needs.
Medscape Orthopaedics & Sports Medicine eJournal 5(3), 2001 Donald Johnson, MD, Moreno Morelli, MD

Achilles Tendon Rupture eMedicine Sports

Jacobs, Lin & Schwartz — 2008-11-19 21:00:48 GMT

Achilles tendon ruptures commonly occur to otherwise healthy men between the ages of 30 and 50 years who have had no previous injury or problem reported in the affected leg. Those who suffer this injury are typically "weekend warriors" who are active intermittently.
Synonyms and related keywords: Achilles tendon rupture, Achilles tendon tear, Achilles tendon injury, Achilles tendon pathology, Achilles injury, Achilles tendon repair, Achilles tendon surgery, heelcord rupture
Jacobs, Lin & Schwartz 2008

Achilles tendon rupture Orthopaedia

Not Available — 2009-06-23 21:00:48 GMT

Achilles tendon ruptures are at the end of the spectrum which includes tendonitis, partial rupture, and complete rupture. Achilles tendon ruptures are the third most common tendon ruptures (Lipscomb et. al., 1956). They are commonly occur in males in poor athletic condition who participate in intermittent recreational sports. Males are more commonly afflicted with a male:female ratio of ranging from 2 to 10:1. Mechanisms associated with ruptures include sudden forced dorsiflexion of the ankle (eccentric contraction of the gastrocnemius and soleus), pushing off with the weight-bearing forefoot while extending the knee, and from a laceration or direct blow to the contracted tendon.

Achilles Tendon Ruptures

Myles Clough — 2003-02-13 21:00:48 GMT

Citations on Achilles Tendon (Heelcord) Ruptures. Uses the search string (Achilles Tendon) [MESH] AND (rupture) [MESH] Can be refined for acute/chronic, treatment, outcome etc.

Achilles Tendon Ruptutre Wheeless

C.R.Wheeless — 2008-11-19 21:00:48 GMT

ruptures typically occur after age 30, more often in people beyond middle age;
- rupture at musculous tendinous junction occurs most often in young people, but ruptures near the calcaneus also occur;
- inciting event may be related to atrophy of the soleus muscle, and commonly occur in weekend athletes;
- in 5-33% of patients there will be a prodromal incident of pain several days beforhand;

Complete Ruptures of the Achilles Tendon Medscape

Atkinson & Easley — 2008-11-19 21:00:48 GMT

Although Achilles tendon ruptures may occur in young athletes, they generally occur in 30- to 40-year-old sedentary males who overexert themselves, usually on weekends. The patient typically presents with pain, ecchymosis, and a history of an audible "pop" in the calf. Usually in these cases, a gap is palpable 2 cm to 6 cm above the insertion of the Achilles tendon; the patient is unable to perform repetitive heel rises; and Thompson, Copeland, and O'Brien tests scores are positive. Usually the diagnosis is made on clinical grounds, but MRI and ultrasound can be useful when the diagnosis is uncertain. During the late 1980s and 1990s, surgical treatment was favored in young active patients and in those with chronic tears. Although simple end-to-end repair achieves good results in acute tears, chronic tears usually require some type of augmentation. The trend in postoperative rehabilitation is moving toward progressive functional protocols.
Medscape Orthopaedics & Sports Medicine eJournal 5(3), 2001 Atkinson & Easley

Less Invasive Achilles Tendon Reconstruction

Carmont and Maffulli — 2008-11-19 21:00:48 GMT

The optimal management of chronic ruptures of the Achilles tendon is surgical reconstruction. Reconstruction of the Achilles tendon using peroneus brevis has been widely reported. Classically, these procedures involve relatively long surgical wounds in a relatively hypovascular area which is susceptible to wound breakdown. Results: We describe our current method of peroneus brevis reconstruction for the Achilles tendon using two para-midline incisions. Conclusion: This technique allows reconstruction of the Achilles tendon using peroneus brevis preserving skin integrity over the site most prone to wound breakdown, and can be especially used to reconstruct the Achilles tendon in the presence of previous surgery.
BMC Musculoskelet Disord. 2007 Carmont and Maffulli

Mechanical properties during healing of Achilles tendon ruptures to predict final outcome

Schepull et al — 2007-11-28 21:00:48 GMT

Mechanical properties during healing of Achilles tendon ruptures to predict final outcome. A pilot Roentgen stereophotogrammetric analysis in 10 patients
Thorsten Schepull , Joanna Kvist , Christer Andersson and Per Aspenberg
BMC Musculoskeletal Disorders 2007, 8:116
Results The strain was median 0.90, 0.32 and 0.14 percent per 100 N tendon force at 6 weeks, 18 weeks and one year respectively. The error of measurement was 0.04 percent units at 18 weeks. There was a large variation between patients, which appears to reflect biological variation. From 6 to 18 weeks, there was a negative correlation between increase in transverse area and increase in material properties, suggesting that healing is regulated at the organ level, to maximize stiffness. Modulus of elasticity during this time correlated with a heel raise index at one year (Rho=0.76; p=0.02).
Conclusion We conclude that the RSA method might have potential for comparing different treatments of Achilles tendon ruptures.

Nonsurgical Treatment May Be Best for Achilles Tendon Rupture Medscape

Not Available — 2008-11-19 21:00:48 GMT

Sept. 25, 2003 � Nonsurgical treatment of Achilles tendon rupture may be best, according to the results of a retrospective cohort study published in the September-October issue of the American Journal of Sports Medicine.

Restoration of Strength Despite Low Stress and Abnormal Imaging after Achilles Injury Medscape

Trudel et al — 2009-12-02 21:00:48 GMT

Purpose: To determine the usefulness of clinical imaging in predicting the mechanical properties of rabbit Achilles tendons after acute injury.
Conclusions: Normal peak loads 4 wk after injury were withstood by an enlarged tendon of lower stress. These findings support progressive physical loading 4 wk after an Achilles tendon injury. T1-weighted OD constituted a marker of tendon mechanical recovery.
Restoration of Strength Despite Low Stress and Abnormal Imaging after Achilles Injury Guy Trudel; Geoffrey P. Doherty; Yoichi Koike; Nanthan Ramachandran; Martin Lecompte; Laurent Dinh; Hans K. Uhthoff Posted: 11/24/2009; Medicine and Science in Sports and Exercise�. 2009;41(11):2009-2016. � 2009

Study Confirms Increased Risk of Achilles Tendon Rupture With Fluoroquinolone Use Medscape

Not Available — 2008-11-19 21:00:48 GMT

Oct. 15, 2003 (San Diego) � Fluoroquinolone use is associated with increased risk of Achilles tendon rupture, and that increase is "true across the board for exposure to any fluoroquinolone," according to results of nested case-control study reported last week at the 41st annual meeting of the Infectious Diseases Society of America.

Tendo Achilles Disorders - Rupture Orthoteers

Not Available — 2008-11-20 21:00:48 GMT

The most common mechanism for TA rupture is pushing off with the weight-bearing forefoot while extending the knee (eccentric contraction of the calf muscles). The same effect can also be created by a sudden unexpected dorsiflexion of the ankle as in a fall from a height.