Achilles Tendon Disorders：跟腱疾病

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1、AchillesTendonDisordersDanielPenelloFoot&AnkleRoundsAnatomyLargesttendoninthebodyOriginfromgastrocnemiusandsoleusmusclesInsertiononcalcanealtuberosityAnatomyLacksatruesynovialsheathParatenonhasvisceralandparietallayersAllowsfor1.5cmoftendonglideAnatomyParateno

2、nAnterior–richlyvascularizedTheremainder–multiplethinmembranesAnatomyBloodsupplyMusculotendinousjunctionOsseousinsertiononcalcaneusMultiplemesotenalvesselsonanteriorsurfaceofparatenon(inadipose)TransversevinculaFewest@2to6cmproximaltoosseousinsertionPhysiology

3、RemarkableresponsetostressExerciseinducestendondiameterincreaseInactivityorimmobilizationcausesrapidatrophyAge-relateddecreasesincelldensity,collagenfibrildiameteranddensityOlderathleteshavehigherinjurysusceptibilityBiomechanicsGastrocnemius-soleus-Achillescom

4、plexSpans3jointsFlexkneePlantarflextibiotalarjointSupinatesubtalarjointUpto10timesbodyweightthroughtendonwhenrunningAchillesTendonRupturePathophysiologyRepetitivemicrotraumainarelativelyhypovasculararea.ReparativeprocessunabletokeepupMaybeonthebackgroundofadeg

5、enerativetendonAchillesTendonRupture:TextbookFactsAntecedenttendinitis/tendinosisin15%75%ofsports-relatedruptureshappeninpatientsbetween30-40yearsofage.Mostrupturesoccurinwatershedarea4cmproximaltothecalcanealinsertion.AchillesTendonRuptureHistoryFeelslikebei

6、ngkickedinthelegCasereportsoffluoroquinoloneuse,steroidinjectionsMechanismEccentricloading(runningbackwardsintennis)Suddenunexpecteddorsiflexionofankle(Directbloworlaceration)PhysicalExamPronepatientwithfeetoveredgeofbedPalpationofentirelengthofmuscle-tendonun

7、itduringactiveandpassiveROMComparetendonwidthtoothersideNotetenderness,crepitation,warmth,swelling,nodularity,palpabledefectsAchillesTendonRupturePhysicalPartialLocalizedtenderness+/-nodularityCompleteDefectCannotheelraisePositiveThompsontestAchillesTendonRupt

8、ureDiagnosticPitfalls23%missedbyPrimaryPhysician(Inglis&Sculco)TendondefectcanbemaskedbyhematomaPlantar-flexionpowerofextrinsicfootflexorsretainedThompsontestcanproduceafalse-negat