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May 06 2015

byron1trujillo5

Have I Sustained An Achilles Tendon Rupture

Overview
Achilles tendinitis About two thirds of all Achilles tendon ruptures occur during sports. Total ruptures are most common in sports with stop-and-go movements, especially ball sports. The majority of patients suffered a ruptured Achilles tendon when stopping suddenly during a fast vigorous movement. Usually the Achilles tendon tears about 5 cm before it inserts into the heel bone. Particularly at risk for a tear are athletes who have already suffered from Achilles tendon problems for some time.

Causes
Often an Achilles rupture can occur spontaneously without any prodromal symptoms. Unfortunately the first "pop" or "snap" that you experience is your Achilles tendon rupture. Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, squash, basketball, soccer, softball and badminton. Achilles rupture can happen in the following situations. You make a forceful push-off with your foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping. You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully over stretching the tendon. You fall from a significant height. It does appear that previous history of Achilles tendonitis results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of rupture.

Symptoms
Ankle pain and swelling or feeling like the ankle has ?given out? after falling or stumbling. A loud audible pop when the ankle is injured. Patients may have a history of prior ankle pain or Achilles tendonitis, and may be active in sports. Swelling, tenderness and possible discoloration or ecchymosis in the Achilles tendon region. Indentation above the injured tendon where the torn tendon may be present. Difficulty moving around or walking. Individual has difficulty or is unable to move their ankle with full range of motion. MRI can confirm disruption or tear in the tendon. Inability to lift the toes.

Diagnosis
Some patients mistakenly believe the tendon is working if they can push the foot down, however, patients will usually be able to move the foot up and down while sitting because the other surrounding muscles and tendons are still intact. Trying to push up while standing and applying body weight to the foot will reveal the true weakness. Sensation and circulation to the foot and ankle will be normal. In addition, x-rays will be normal unless the Achilles injury involves pulling off (avulsion) of the bone on the calcaneus (heel bone). This is quite rare, occurring in only a small fraction of patients with Achilles injuries. Patients suffering this type of Achilles avulsion injury tend to be older with weaker bone. Imaging Studies. Plain x-rays will be negative in patients who have suffered an Achilles tendon rupture. The rupture can be seen on ultrasound or MRI. However, these studies are not indicated for acute ruptures unless there is some uncertainty about the diagnosis. For chronic problems of the Achilles or ruptures that are old, an MRI may be very helpful.

Non Surgical Treatment
Non-surgical treatment typically involves wearing a brace or cast for the first six weeks following the injury to allow time for the ends of the torn tendon to reattach on their own. Over-the-counter medications, such as ibuprofen or aspirin, may be taken during this time to reduce pain and swelling. Once the tendon has reattached, physical therapy will be needed to strengthen the muscles and tendon. A full recovery is usually made within four to six months. Achilles tendonitis

Surgical Treatment
The patient is positioned prone after administration of either general or regional anesthesia. A longitudinal incision is made on either the medial or lateral aspect of the tendon. If a lateral incision is chosen care must be taken to identify and protect the sural nerve. Length of the incision averages 3 to 10 cm. Once the paratenon is incised longitudinally, the tendon ends are easily identifies. These are then re-approximated with either a Bunnell or Kessler or Krackow type suture technique with nonabsorbable suture. Next, the epitenon is repaired with a cross stitch technique. The paratenon should be repaired if it will be useful to prevent adhesions. Finally, a meticulous skin closure will limit wound complications. An alternative method is to perform a percutaneous technique, with a small incision (ranging from 2-4 cm). A few salient points include: the incision should be extended as needed, no self-retaining retractors should be used, and meticulous paratenon and wound closure is essential. Postoperatively the patient is immobilized in an equinous splint (usually 10?-15?) for 2 weeks. Immobilization may be extended if there is any concern about wound healing. At the 2-week follow-up, full weight bearing is permitted using a solid removable boot. At 6 weeks, aggressive physical therapy is prescribed and the patient uses the boot only for outdoor activity. At 12 weeks postoperatively, no further orthosis is recommended.

Prevention
Achilles tendon rupture can be prevented by avoiding chronic injury to the Achilles tendon (i.e. tendonitis), as well as being careful to warm up and stretch properly before physical activity. Additionally, be sure to use properly fitting equipment (e.g. running shoes) and correct training techniques to avoid this problem!

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