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Lower Leg and Ankle Radiography
Published in Russell L. Wilson, Chiropractic Radiography and Quality Assurance Handbook, 2020
The ankle is the most commonly injured weight-bearing joint in the athlete who engages in running, skiing, basketball, and/or gymnastics. Most (85%) injuries are inversion sprains. The less-frequent eversion sprain can also result in an avulsion of the medial malleolus. The Achilles tendon rupture results from a sudden contraction of the gastrocnemius and soleus muscles; for example, in pushing off with the knee extended or forced dorsi flexion as in landing from a jump. Ankle fractures are classified by anatomical location: unimalleolar, bimalleolar, or trimalleolar. They result from inversion, eversion, or a combination of both. A common nonathletic source of severe ankle fractures are platform shoes.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Trauma – soft tissue injury will not normally require plain X-ray image examination except to look for an opaque foreign body. For superficial injury without large surface abrasion, ultrasound may determine the depth of injury, demonstrate retained foreign body (including non-radio-opaque bodies) and can demonstrate muscle and tendon tears and haematoma in localised injury. MRI offers a more comprehensive overview of the area and can detect subtle signal alterations indicating muscle injury with greater sensitivity than ultrasound. Tendon tears in areas amenable to ultrasound can often be diagnosed without recourse to MRI, and in the case of Achilles tendon rupture can indicate whether or not the tendon ends can be apposed by fixed flexion of the ankle (conservative management).
Case 49
Published in Edward Schwarz, Tomos Richards, Cases of a Hollywood Doctor, 2019
Edward Schwarz, Tomos Richards
An Achilles tendon rupture is a clinical diagnosis based on the history and examination, especially the calf squeeze test. This is also known as ‘Simmond’s test’ or ‘Thompson’s test’. (Interestingly, Simmond’s described this test several years before but it is widely called the ‘Thompson’s test’.) This is a way of assessing the integrity of the tendon. The patient lies in the prone position on a bed, or kneels on a chair facing backwards, with their feet slightly hanging off the end. On squeezing the calf, a normal intact tendon will plantar-flex the foot. Absence of this movement suggests an Achilles tendon rupture. In any cases of uncertainty, an ultrasound scan or even MRI may aid the diagnosis.
Autologous conditioned serum for degenerative diseases and prospects
Published in Growth Factors, 2021
Seyed Kazem Shakouri, Sanam Dolati, Jessica Santhakumar, Avnesh S. Thakor, Reza Yarani
Rupture of the Achilles tendon is the most common tendon rupture in the adult population. Though conventional and surgical treatment methods are available, recent studies usually recommend surgical procedures (Maquirriain 2011). As a result of frequent and severe complications of Achilles tendon rupture treatments, post-operative additive biological procedures are typically performed (Sarıkaya et al. 2017; YükSel et al. 2015). ACS may be favorable for the treatment of human Achilles tendon injuries and tendinopathies (Genç et al. 2018). ACS treatment increased the expression of collagen I and had a significant effect on the histological appearance and mechanical resistance during tendon regeneration (Majewski et al. 2009). The ACS-treated tendons were thicker, had more type I collagen, and displayed an accelerated recovery of tendon stiffness and histologic maturity of the repair tissue (Geburek et al. 2015).
Morphological and functional outcomes of operatively treated Achilles tendon ruptures
Published in The Physician and Sportsmedicine, 2020
Gareth Nicholson, Josh Walker, Zoe Dawson, Athanassios Bissas, Nick Harris
Apart from functional deficits, Achilles tendon rupture results in alterations of the neuromechanical properties of the muscle-tendon unit including tendon elongation, triceps surae atrophy and compensatory changes in muscle activation [12,13,16]. Manegold and coworkers [17] showed that Achilles tendon elongation and tricep surae atrophy are related to the deficits in strength and ROM that are often seen in the ankle joint. This remains one of the few studies that has sought to understand the mechanisms underpinning deficits in functional outcomes. In terms of muscle morphology, recent studies [16,18] have suggested medial gastrocnemius remodeling following Achilles tendon rupture (larger pennation, reduced thickness, reduced aponeurosis stiffness, and shorter fascicles) as a compensatory mechanism to restore resting tendon tension. However, the same remodeling changes have been found to be connected to impairments in the triceps surae function as it was measured through heel-raise tests [16,18,19]. Although these studies provide important information about morphological remodeling, they have not integrated a wide range of functional tasks (e.g. jumping) alongside the morphological measures nor have these studies investigated post-surgery periods longer than 2.5 years.
Higher Rate of Postoperative Complications in Delayed Achilles Tendon Repair Compared to Early Achilles Tendon Repair: A Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Shu-Kun He, Jing-Ping Liao, Fu-Guo Huang
The cause of Achilles tendon ruptures remains unclear, but risk factors include higher age (> 60 years), higher weight, present of inflammatory disorders and history of oral quinolone or corticosteroid use.19 An acute Achilles tendon rupture is often described as getting hit in the area of the ankle and the pain may be not severe. Thus, patients may not go to hospital immediately, and after several weeks or months, significant alteration in gait and continued functional impairment cause the patient to pursue treatment. Achilles tendon ruptures are commonly diagnosed with injury history and physical examination (such as a palpable gap). The Thompson test could assist in diagnosis, however, it is not reliable in chronic ruptures.20 Other tests, including the Matles knee flexion test21, the O’Brien needle test22 and the Copeland sphygmomanometer test23, also provide useful information about diagnosis. Maffulli et al24 evaluated the sensitivity and specificity of all mentioned tests, and they found that the Thompson test and the Matles test were more sensitive than the other tests. Radiography, ultrasonography and magnetic resonance imaging (MRI) are useful in the diagnosis of chronic Achilles tendon ruptures. A loss in definition of the Kager triangle could be seen in a lateral ankle radiograph when patients have suspected chronic Achilles ruptures.25 Ultrasonography is a cost-effective approach and allows dynamic imaging, however, its sensitivity is highly operator dependent.26 MRI provides more detailed information on the ruptured tendon and surrounding structures, and it is also useful for detecting partial ruptures.27