Achilles tendon rupture: how to avoid missing the diagnosis

Boyd, R; Dimock, Richard; Solan, Matthew; Porter, Edward C.

doi:10.3399/bjgp15x688069

Cited by 21 publications

(24 citation statements)

References 5 publications

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“…Radiography may be used, but the radiographic findings are subtle, widely missed by many clinicians, and have mostly fallen out of favor. MRI may also be utilized but is expensive, time-consuming, inferior to US, and often not readily available or necessary to make the initial diagnosis of an ATR [15,16,18].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the cadaveric calf muscles and AT did not shorten after the incision was made using the scalpel, as it usually would in an acute setting. Also, in the acute setting, hematomas are often useful adjuncts to finding the location of an ATR [18]. Prior to data acquisition, attempts were made to simulate hematoma formation around the artificially created ATRs.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Hands-On Versus Online Learning in Teaching Ultrasound Skills for Achilles Tendon Rupture: A Pilot Study

Das¹,

Kapoor²,

Brown³

et al. 2020

Cureus

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In the emergency department, the diagnosis of an Achilles tendon rupture (ATR) is reportedly missed in greater than 20% of cases. A limited number of studies evaluate the use of cadaver models as a potential ultrasound teaching and training modality. We hypothesize that emergency medicine residents can effectively utilize point-of-care ultrasound (POCUS) on cadaver models and a focused teaching intervention to assess their ability to detect ATRs. Methods A prospective study of 23 EM residents was performed. All participants in the study were divided into two learner groups: (a) independent and (b) hands-on. The independent learner group received a 30-minute online didactic lecture demonstrating how to diagnose ATRs. The hands-on learner group received direct instruction on cadaver lower leg models with a ruptured and normal Achilles tendon (AT). Both groups then participated in identifying either normal or ruptured ATs on six cadaver lower leg models. Results The sensitivity and specificity were 89% and 82% in the independent learner group 96% and 100% in the hands-on learner group, respectively. The overall sensitivity and specificity were 91% and 88%, respectively. There was a trend toward successful identification with increased years of residency training. Conclusions In this study, lower leg and ankle cadaver models were found to be as effective as an independent learner model for potential POCUS teaching and training modality in both novice and more advanced trainees.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Hands-On Versus Online Learning in Teaching Ultrasound Skills for Achilles Tendon Rupture: A Pilot Study

Das¹,

Kapoor²,

Brown³

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…This is because patients may still be able to walk or plantar flex due to the contribution of the posterior tibial, peroneal and plantar muscles or an intact plantaris tendon [8]. In addition, soft tissue swelling or organised haematoma can hinder palpation of a tendon gap [8] [9]. Inefficiencies in the service provided by Emergency, Radiology, Orthopaedic or Sports Medicine departments within the National Health Service (NHS) can also contribute towards delayed diagnosis or suboptimal management, with significant implications for patient morbidity and cost to the NHS and wider economy.…”

Section: P R O O Fmentioning

confidence: 99%

A retrospective audit of the timescales involved in the diagnosis and management of suspected Achilles tendon ruptures at a single National Health Service trust: A quality service improvement and redesign project

et al. 2021

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Introduction The Achilles tendon is the most frequently ruptured tendon. Prompt diagnosis of this injury ensures optimal management decisions are instituted early ensuring the best outcome and patient experience, at minimal cost to the United Kingdom National Health Service. Despite this, regional and national variations to diagnosis and management exist, with anecdotal evidence of inefficiencies in the local patient pathway. To explore this further, a retrospective departmental audit of timescales from presentation to ultrasound diagnosis and definitive treatment decision was undertaken. Methods All suspected Achilles tendon ruptures in 2018 were identified through electronic and written patient records, and information on timescales involved in the diagnosis and management of each compiled. Descriptive statistics were used to map each step of the pathway and timescales involved, with performance assessed against local departmental standards and the Swansea Morriston Achilles Rupture Treatment (SMART) protocol. Results In total, 119 patients were identified, of which 113 received an ultrasound examination. Local departmental standards were met in the majority of cases, with 78% (n = 88) diagnosed by ultrasound within one week of the request and 83% (n = 91) given a treatment decision within two weeks of presentation. However, this was suboptimal when compared with timeframes utilised for developing the SMART protocol, with only 7% (n = 8) scanned within 48 hours of presentation. Conclusions Key areas of the patient pathway were identified for quality service improvement and redesign, with multidisciplinary discussion resulting in the development of a revised patient pathway which expedites diagnosis and treatment for these injuries.

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“…This is where a patient lies prone with feet hanging off the bed. The test is positive if, on squeezing the calf, the corresponding foot does not dorsiflex (Boyd et al., 2015). Tendon rupture can also occur in the patellar tendon, and so should be considered in presentations of anterior knee pain.…”

Section: Red Flags and Differential Diagnosesmentioning

confidence: 99%