From the Guidelines
The diagnosis of Achilles tendon rupture should be established through a detailed history and physical examination, including two or more of the following tests: Clinical Thompson test, decreased ankle plantar flexion strength, presence of a palpable gap, and increased passive ankle dorsiflexion with gentle manipulation. When evaluating a patient for Achilles tendon rupture, it is essential to consider the results of the physical examination, as recommended by the work group in their study published in The Journal of the American Academy of Orthopaedic Surgeons 1. The physical examination should include tests such as:
- Clinical Thompson test (ie, Simonds squeeze test)
- Decreased ankle plantar flexion strength
- Presence of a palpable gap (defect, loss of contour)
- Increased passive ankle dorsiflexion with gentle manipulation These tests can help establish the diagnosis of acute Achilles tendon rupture, as noted in the study 1. It is also important to consider the use of additional diagnostic tools, such as ultrasonography and MRI, to confirm the extent of the tear in patients treated nonsurgically, as mentioned in the study 1. However, the primary diagnosis should be based on the physical examination, as it is the most reliable and efficient method for diagnosing Achilles tendon rupture, according to the study 1.
From the Research
Diagnostic Tests for Achilles Tendon Rupture
The diagnostic tests for Achilles tendon rupture include:
- Clinical examination, such as the Thompson test, to check for a palpable defect and decreased resting tension 2
- Ultrasound examination to evaluate the tendon and detect any rupture or adaptation of the tendon ends 3, 4, 5
- Magnetic Resonance Imaging (MRI) to verify the rupture and provide more information about the tendon structure, although it is not necessary for diagnosis and can lead to treatment delays 2
- Realtime Achilles Ultrasound Thompson (RAUT) test, which is a sensitive and specific test for diagnosing acute Achilles tendon ruptures 4
- Sonographic control examinations after 4 and 8 weeks to document the course of healing and detect any potential complications 5
- Acute ultrasonography investigation to measure the diastasis between the tendon ends and predict the risk of reruptures and outcomes after treatment 6
Characteristics of Diagnostic Tests
The characteristics of the diagnostic tests are:
- Ultrasound examination: sensitive, specific, and cost-effective 3, 4
- MRI: not necessary for diagnosis, time-consuming, and expensive 2
- RAUT test: sensitive, specific, and provides substantial agreement among novice and expert reviewers 4
- Acute ultrasonography investigation: useful for predicting the risk of rerupture and functional deficit, and may be an important measure in a clinical treatment algorithm 6
Clinical Applications
The diagnostic tests have the following clinical applications:
- Ultrasound examination: used to determine the localization of the Achilles tendon, detect any rupture or adaptation of the tendon ends, and monitor the course of healing 3, 5
- MRI: used to verify the rupture and provide more information about the tendon structure, although it is not necessary for diagnosis 2
- RAUT test: used to aid in the diagnosis of acute Achilles tendon ruptures, especially in situations with a large hematoma 4
- Acute ultrasonography investigation: used to predict the risk of rerupture and functional deficit, and may be an important measure in a clinical treatment algorithm 6