The Role of POCUS in Diagnosing Achilles Tendon Rupture: A Case Report
Dr Himanshu Gul Mirani
Case Presentation:
A male in his 30s presented to the Emergency Department (ED) after accidentally striking the back of his leg against a ladder rung. He reported immediate swelling over the Achilles tendon and an inability to dorsiflex the foot. Physical examination revealed no movement on calf compression (negative Thompson test), strongly suggestive of an Achilles tendon rupture.
Ruptured and Intact Achilles tendon
Management and Outcome:
Point-of-care ultrasound (POCUS) was performed, revealing a complete rupture of the Achilles tendon with discontinuity of tendon fibres, retracted tendon ends, and a hypoechoic hematoma in the gap. Comparison with the contralateral side confirmed normal tendon anatomy.
Based on these findings, the patient was promptly referred to orthopaedics for operative intervention.
Key Learnings and Points:
POCUS allows for bedside visualization of tendon structure, offering real-time assessment of fibre integrity and associated findings like hematomas or retraction. In this case, the hallmark sonographic signs of a complete rupture viz tendon discontinuity and retracted ends enabled an expedited diagnosis and referral.
Studies highlight the diagnostic accuracy of POCUS for Achilles tendon injuries. Hutchison et al. (2013) reported a sensitivity of 100% and a specificity of 83%, emphasizing its ability to differentiate between complete and partial ruptures. Additionally, Lee et al. (2018) demonstrated the value of POCUS in out-of-hours ED presentations, reducing reliance on MRI and enabling timely intervention.
In this case, POCUS was pivotal in confirming the diagnosis and guiding management, expediting referral for surgical intervention. This aligns with findings from case series and studies where POCUS reduced delays in care and facilitated the differentiation of tendon pathologies from other soft tissue injuries, such as hematomas or tendinitis.