MSK clinical application-achilles tendon rupture

Question 1

where does rupture of the achilles tendon normally occur?

Answer 1

within 1-2 in above its tendinous insertion on the calcaneus

Question 2

what tendon is the largest and strongest tendon in the body?

Answer 2

the achilles tendon

Question 3

what is the achilles tendon formed from?

Answer 3

the tendinous portions of the gastroc and soleus muscles coalescing above the insertion on the calcaneal tuberosity

Question 4

achilles tendon rupture usually occurs in an achilles tendon that has undergone __ changes

Answer 4

degenerative changes

Question 5

symptoms of achilles tendon rupture present secondarily to the __ and __ of the tendon

Answer 5

rupture and discontinuity

Question 6

degenerative changes of the achilles tendon begin with __ in the achilles tendon area

Answer 6

hypovascularity

Question 7

impaired __ __ with repetitive __ creates degenerative changes within the tendon and makes it more susceptible to injury

Answer 7

blood flow; microtrauma

Question 8

achilles tendon rupture frequently occurs with what different mechanisms of injury (3)?

Answer 8

pushing off of a weight bearing extremity with an extended knee
unexpected DF while weight bearing
forceful eccentric contraction of the PF

Question 9

participation in sports requiring what are considered high-risk activities for achilles tendon rupture?

Answer 9

quick-changing footwork

Question 10

what sports (4) require quick-changing foot work and are considered high-risk activities for achilles tendon rupture?

Answer 10

softball
basketball
tennis
football

Question 11

what other factors (4) are considered contributing factors for achilles tendon rupture?

Answer 11

poor stretching routine
tight calf muscles
improper shoe wear during high risk activity
altered biomechanics at the foot (like a flattened arch) during activities

Question 12

a person over __ years of age is at increased risk for achilles tendon rupture secondary to age associated __ in blood flow to the area of the tendon

Answer 12

30; decrease

Question 13

a person with a history of what type of injections to the achilles tendon may have a predisposition for achilles tendon rupture

Answer 13

corticosteroid

Question 14

the highest incidence of achilles tendon rupture is in individuals between __-__ years of age

Answer 14

30-50

Question 15

the highest incidence of achilles tendon rupture is in individuals between 30-50 years of age who usually have no history of __ or __ pain and commonly participate in __ activities

Answer 15

calf or heel pain; recreational activities

Question 16

what signs and symptoms (5) will an individual with an achilles tendon rupture present with?

Answer 16

swelling over the distal tendon
palpable defect in tendon above the calcaneal tuberosity
pain and weakness with plantarflexion
walk with a limp
reported severely painful snap or pop with injury

Question 17

an individual with an achilles tendon rupture will not be able to stand on their __

Answer 17

toes

Question 18

an individual with an achilles tendon rupture will demonstrate a positive __ test

Answer 18

Thompson test

Question 19

what does a positive Thompson test clinically present as?

Answer 19

lack of passive PF with squeezing of the affected calf muscles in prone

Question 20

a complete achilles tendon rupture will result in a palpable __ in the tendon prior to the insertion

Answer 20

gap

Question 21

confirmation of an achilles tendon rupture should utilize what imaging technique? why?

Answer 21

xray- to rule out an avulsion fx or bony injury

Question 22

an MRI can be used to locate the __ and __ of an achilles tendon tear or rupture

Answer 22

presence; severity

Question 23

diagnosis of an achilles tendon rupture relies on patient __ __ __ and a positive __ test

Answer 23

history of event (usually reveals popping sound)
Thompson

Question 24

what other special test can be used by the physician to confirm achilles tendon rupture?

Answer 24

O’brien needle test

Question 25

O'brien needle test (used by physician)

Answer 25

During passive DF and PF with needle inserted into achilles tendon: If a rupture is present: the hub of the needle does not tilt or move If there is no rupture: the motion of the needle hub is in the opposite direction of the tendon during passive dorsiflexion and plantarflexion of the foot

Question 26

achilles tendon rupture is more common in males or females and in individuals that do not __ exercise (weekend warriors)

Answer 26

males; consistently

Question 27

what areas (8) of subjective history are important to document for an achilles tendon rupture?

Answer 27

MOI PMH medications current health status social history/habits occupation living environment social support system

Question 28

what tests and measures (11) are most appropriate to utilize during the objective portion of an exam/treatment session with a patient with an achilles tendon rupture?

Answer 28

antrhopometrics: circumferential edema measurement, palpation to determine ankle effusion arousal, attention, cognition: mental status, learning ability, memory and motivation pain: pain perception assessment scale A/PROM muscle performance: strength assessment, characteristics of muscle contraction integumentary integrity: sensation assessment sensory integration: proprioception and kinesthesia joint integrity and mobility: special tests (Thompson's test) gait, locomotion and balance: safety with/without AD during gait; gait biomechanics self-care and home management: assessment of functional capacity assistive and adaptive devices: consider potential utilization of crutches

Question 29

what should the course of treatment for a patient with achilles tendon rupture be based on when considering conservative versus surgical treatment?

Answer 29

physician typically determines the course of treatment on a patient-by-patient basis accounting for patient age, activity level and co-morbidities

Question 30

what are the forms of effective medical management of achilles tendon rupture?

Answer 30

conservative: immobilization through casting surgical approach: repair v reconstruction

Question 31

what type of casting is used and for how long is achilles tendon rupture immobilized through conservative casting?

Answer 31

serial casting for approximately 10 weeks

Question 32

conservative management of an achilles tendon rupture through serial casting for approx 10 weeks, is typically followed by...

Answer 32

physical therapy use of a heel lift for 3-6 mo to ensure maximal healing w/o stress on tendon

Question 33

when does physical therapy typically begin for a patient conservatively managing an achilles tendon rupture?

Answer 33

after the serial cast is removed (approx. 10 weeks after initial casting)

Question 34

how long does a patient typically wear a heel lift following serial casting for medical management of an achilles tendon rupture? why?

Answer 34

3-6 months- to ensure maximal healing without added stress on the tendon

Question 35

if a patient with an achilles tendon rupture requires surgical intervention, a cast or brace is required for __-__ weeks post-operatively

Answer 35

6-8

Question 36

when should physical therapy begin for a patient about to undergo achilles tendon repair/reconstruction surgery?

Answer 36

after surgical intervention

Question 37

PT is primarily the same for surgical and non-surgical patients-what are the general, important physical therapy interventions utilized for patients status post serial casting or surgical intervention following achilles tendon rupture?

Answer 37

ROM stretching ice AD training endurance gait training strength plyometrics skill specific training modalities consider pool therapy consider cardiovascular gym equipment

Question 38

assuming an unremarkable recovery, when should a patient status post achilles tendon repair/reconstruction expect to return to their previous functional level?

Answer 38

within 6-7 months following surgery

Question 39

what should the home exercise program of a patient status post achilles reconstruction/repair consider?

Answer 39

post-op impairments physician 's post-op protocol

Question 40

how long is a patient status post achilles repair/recontruction typically required to continue with their home exercise program?

Answer 40

throughout the 6-7 months of rehabilitation

Question 41

the home exercise program of a patient status post achilles reconstruction/repair in the early phase of rehabilitation generally incorporates..

Answer 41

ice elevation

Question 42

a patient that manages achilles tendon rupture without surgery and allows the tendon to heal on its own has a __ rate of re-rupture compared to a patient that has surgical repair of the tendon.

Answer 42

higher

Question 43

a patient that manages achilles tendon rupture without surgery and allows the tendon to heal on its own has a __ % chance of re-rupture

Answer 43

40%

Question 44

a patient that manages achilles tendon rupture with surgery has a __% chance of re-rupture

Answer 44

0-5%

Question 45

a patient who conservatively manages an achilles rupture is at reduced risk for..

Answer 45

infection from surgery

Question 46

conservatively managing an achilles tendon rupture may result in an __ return to functional performance compared to surgical management of the same condition

Answer 46

incomplete

Question 47

a patient that has surgical intervention for an achilles tendon rupture has a __ risk for reinjury and a __ rate of return to athletic activity

Answer 47

decreased; higher

Question 48

A 32 year old female was playing rec soccer and fell to the ground after experiencing a painful pop in her ankle while kicking a ball during her game. Upon examination, she has some active PF in the affected ankle, but only in a non weightbearing position, and has a notable separation in the achilles tendon with palpation-what injury did this patient likely sustain? what key words lead you to this condition/dx?

Answer 48

achilles tendon rupture key words: age, MOI, painful pop, inability to to actively PF against gravity, notable tendon separation upon palpation

Question 49

an achilles tendon repair is typically performed on __ patients with an achilles tendon tear

Answer 49

active

Question 50

when an achilles tendon repair is performed within days of the injury, it is generally done __

Answer 50

arthroscopically

Question 51

when an achilles tendon repair is delayed after injury, it is generally done as an __ procedure

Answer 51

open

Question 52

what is an arthroscopic surgical procedure

Answer 52

minimally invasive able to create a smaller incision by inserting a thin, telescope-like instrument called an arthroscope

Question 53

what is an open surgical procedure

Answer 53

involves larger incisions in comparison to arthroscopic procedures in order to directly visualize the surgical area

Question 54

in arthroscopic achilles tendon repair, the torn tendon is __ back together

Answer 54

sutured

Question 55

in some cases, instead of suturing the originally torn tendon back together, achilles tendon repair is done using __

Answer 55

grafts

Question 56

what muscles (3) are most commonly used for achilles tendon grafting during surgical repair?

Answer 56

flexor hallucis longus fibularis brevis plantaris

Question 57

initially after achilles tendon repair surgery, the patient will be casted with the ankle in slight __

Answer 57

PF

Question 58

the patient may be placed on __ weightbearing status for the first several weeks following achilles tendon repair surgery

Answer 58

non-weightbearing

Question 59

several weeks after achilles tendon repair, the patient will be transitioned into a cast or boot that places the ankle in __ and they are allowed to be __ weightbearing

Answer 59

neutral; partial

Question 60

recently, there has been a push for more aggressive rehab following achilles tendon repair surgery, in which the ankle is initially casted in __ following sx as opposed to in slight PF and __ weight bearing is allowed much sooner in the recovery process

Answer 60

neutral; partial

Question 61

why has there been a push for more aggressive rehab following achilles tendon repair surgery in the past few decades?

Answer 61

researchers have found it leads to less restricted ROM long term

Question 62

following achilles tendon repair, physical therapists should take caution with exercises that __ the achilles tendon until the tendon is well healed

Answer 62

stretch