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1、RebeccaAspden,HMSIIIGillianLieberman,MDAchillesTendonRuptureAchillesTendonRuptureRebeccaAspden,HarvardMedicalSchoolYearIIIGillianLieberman,MDNovember15,20041RebeccaAspden,HMSIIIGillianLieberman,MDAchillestendon:•Largesttendoninbody.•Formedfromconjoinedtendonsofgastrocnemiusandsoleusmuscles.•I
2、nsertsoncalcaneus.•Contributestowww.medicalmultimediagroup.complantarflexionoffoot.2RebeccaAspden,HMSIIIGillianLieberman,MDTypesofAchillesTendonTypesofAchillesTendonInjuryInjuryòPeritendinosis(peritendinitis)–Edemaandscarringofparatenon(fattyareolartissuearoundtendon).–Acutepainandswelling.–S
3、eeninrunnerswhoincreasetheirtrainingorrunonunevensurfaces.òTendinosis–Intrasubstancedegenerationoftendonitself.òTears(partialorcomplete)–Vulnerablezoneofavascularity2-6cmabovecalcanealinsertion.3RebeccaAspden,HMSIIIGillianLieberman,MDWhogetstears?Whogetstears?•Averageage35-40.•Sportsactisofte
4、ntriggeringfactor.•“WeekendWarrior”•Inelderlyunderlyingsystemicdiseaseorlong-termcorticosteroidmedicationmaycontribute.•Chronicdegenerationoftendon(tendinosis)maybepredisposingfactor.4RebeccaAspden,HMSIIIGillianLieberman,MDOurpatientOurpatientMr.Sisa37year-oldmanwhowasplayingbasketballatthelo
5、calYMCAonSaturdayafternoon.EventhoughMr.Swasaseriousathleteincollege,intheyearssincegraduationheonlymakesittothegymonceaweekforapick-upgamewithhisbuddiesfromtheoffice.Ashewasstartingtochaseaftertheball,Mr.Sfeltasuddenpaininhisleftcalfandheardasnap.Hethoughthehadbeenshot!Hecouldnotwalkandimmed
6、iatelylimpedtothesideline.5RebeccaAspden,HMSIIIGillianLieberman,MDDiagnosisDiagnosisDiagnosisofAchillesTendonrupturecanalmostalwaysbemadeclinically.•Lookfor:–Palpablegapintendon–PositiveThompsontest–Difficultystandingontoes–TendernessUpToDate6RebeccaAspden,HMSIIIGillianLieberman,MDImagingOpti
7、onsImagingOptionsòPlainfilmsarenotveryhelpful.òInquestionablecasesultrasoundcanprovidedefinitivediagnosis(particularlygoodindifferentiatingpartialfromcompleterupture).òMRIhelpfulinplanningsurgeryandinidentifyingintratendonabnormalitiessuchast
