Thompson Test for Achilles Tendon Rupture

The Achilles tendon is the largest and strongest tendon in the human body. It connects the calf muscles to the heel bone. Despite its strength, it can easily get injured, leading to severe ruptures.

Early diagnosis is key for proper treatment and recovery. The Thompson Test, also known as the Calf Squeeze Test or Simmond’s Test, is a reliable way to diagnose complete tears of the Achilles tendon.

This article will explore the anatomy of the Achilles tendon and common causes of ruptures. It will provide a step-by-step guide on how to perform the Thompson Test and interpret its results. We will also discuss other diagnostic tests, treatment options, and rehabilitation strategies for Achilles tendon ruptures. This will help you understand this injury and its management better.

What is an Achilles Tendon Rupture?

The Achilles tendon is the largest and strongest tendon in our bodies. It connects the calf muscles to the heel bone. This tendon is vital for walking, running, and jumping.

Knowing how the Achilles tendon works is important. It helps us understand and treat injuries like ruptures.

Anatomy of the Achilles Tendon

The Achilles tendon is made of fibrous tissue. It starts from the calf muscles and ends at the heel bone. This structure lets it handle a lot of force during activities.

But, it can also get injured if it’s stressed too much.

Common Causes of Achilles Tendon Ruptures

Achilles tendon ruptures can happen for many reasons. They can be caused by sudden injuries or by doing the same thing over and over again. Here are some common reasons:

• Sudden, forceful movements: Quick actions like sprinting or jumping can stress the tendon too much.
• Overuse and repetitive strain: Doing activities that stress the tendon a lot, like long-distance running, can weaken it.
• Degeneration and aging: As we get older, our tendons can lose strength. Conditions like tendinitis can also make them more likely to rupture.

It’s important to know the signs of an Achilles tendon rupture. Doctors use physical exams and imaging to diagnose and treat it. By understanding the anatomy and causes of ruptures, we can prevent them and keep our legs healthy.

Symptoms of an Achilles Tendon Rupture

It’s important to know the signs of an Achilles tendon rupture to get help quickly. People often notice a mix of symptoms that doctors use to diagnose this injury.

Pain and Swelling

Sudden, severe pain in the back of the lower leg is a common symptom. It feels like a sharp kick or hit. After the injury, swelling around the tendon shows that a rupture has happened.

Difficulty Walking or Bearing Weight

Having trouble walking or standing on the hurt leg is another symptom. People might feel weak, unstable, or like they’re about to fall. It can be hard to walk or climb stairs because of this.

Visible Deformity or Gap

At times, a visible gap or deformity can be seen where the tendon ruptured. This happens when the tendon fully separates, leaving a noticeable dent in the leg. People might also hear a popping or snapping sound when it happens.

Diagnostic Tests for Achilles Tendon Ruptures

Getting an Achilles tendon rupture diagnosis right is key for the right treatment. Doctors use physical examination and diagnostic tests to check the injury’s extent and presence.

The first step is a detailed physical examination. Doctors will see how well you walk and move. They’ll also look for swelling, bruises, or any unusual shapes in your ankle and foot. Touching the Achilles tendon can show a gap or soreness where it’s torn.

Along with the physical examination, doctors might use diagnostic tests to confirm the Achilles tendon rupture diagnosis. These tests give clear proof of the injury and help decide the best treatment. Common diagnostic tests for Achilles tendon ruptures include:

• Thompson Test
• Ultrasound imaging
• Magnetic Resonance Imaging (MRI)

The Thompson Test, or calf squeeze test, is a common physical examination for diagnosing Achilles tendon ruptures. The patient lies face down with their feet hanging off the table. The doctor then squeezes the calf muscle. If the tendon is healthy, the foot will point down. But if it’s ruptured, the foot won’t move, showing a positive test result.

By combining the results from the physical examination and diagnostic tests, doctors can accurately diagnose Achilles tendon ruptures. They can then create a treatment plan to help the tendon heal well. In the next sections, we’ll look at each of these diagnostic tests in more detail.

Thompson Test for Achilles Tendon Rupture

The Thompson Test, also known as the calf squeeze test or Simmond’s test, is a simple way to check for Achilles tendon ruptures. It tests the tendon by seeing if the calf muscles contract. This test helps doctors decide the best treatment.

How to Perform the Thompson Test

To do the Thompson Test, follow these steps:

1. Have the patient lie face down on the table with their feet hanging off.
2. Squeeze the calf muscle of the affected leg at its widest point.
3. Look for any movement in the foot, like it pointing down.
4. Compare this to the other leg’s response.

Make sure the patient is relaxed and the squeeze is strong enough to get a response. Don’t confuse this test with the semitendinosus reflex, which makes the knee bend.

Interpreting the Results of the Thompson Test

Here’s how to understand the test results:

• Positive Test: No foot movement means a complete tear of the tendon.
• Negative Test: Foot movement means the tendon is likely intact or partially torn.

If the test is positive, more tests like ultrasound or MRI might be needed. A positive test, along with a tendon defect and a history of injury, points to a complete tear.

Other Physical Examination Techniques

Several physical examination techniques, aside from the Thompson test, help diagnose an Achilles tendon rupture. These methods give important insights into the tendon’s health and function. They help doctors make accurate diagnoses and plan the best treatment.

Palpation of the Achilles Tendon

Palpation is a gentle touch along the Achilles tendon to find any gaps or tenderness. A complete rupture often shows a noticeable gap 2-6 cm above the heel. It also reveals swelling and tenderness.

Range of Motion Assessment

Checking the range of motion of the ankle is key. Patients with a rupture struggle to point their toes down. Doctors compare the injured and healthy legs to spot any issues.

Strength Testing

Strength testing looks at how well the calf muscles work. Patients with a rupture find it hard to raise their heel on the affected side. Doctors might ask them to stand on their toes to check muscle strength.

By using findings from palpation, range of motion, and strength tests, doctors can accurately diagnose an Achilles tendon rupture. They then create a treatment plan that fits the patient’s needs.

Imaging Studies for Achilles Tendon Ruptures

When someone shows signs of an Achilles tendon rupture, imaging studies are key. They help confirm the diagnosis and see how bad the injury is. The main tools used are ultrasound and magnetic resonance imaging (MRI).

Ultrasound

Ultrasound is a non-invasive method that shows the Achilles tendon in real-time. It lets doctors see how the tendon moves and find the rupture’s size and location. It’s very good at spotting tendon ruptures.

Ultrasound is great because:

Magnetic Resonance Imaging (MRI)

MRI is also important for checking Achilles tendon ruptures. It gives detailed pictures of the tendon and the area around it. This helps doctors understand the rupture’s size and location. MRI can also spot other injuries or problems that might have caused the rupture.

MRI is good because:

Choosing between ultrasound and MRI depends on the situation. Both have their own benefits and help doctors decide the best treatment for Achilles tendon ruptures.

Treatment Options for Achilles Tendon Ruptures

When someone gets an Achilles tendon rupture, they and their doctor have to think about treatment. They look at how bad the rupture is, the patient’s age, health, and how active they want to be.

The table below shows the main ways to treat Achilles tendon ruptures. It lists the good and bad sides of each:

For people who are very active and want to get back to sports, surgery is often the best choice. It fixes the tendon and helps you get strong again. This way, you’re less likely to have it happen again.

But, if you’re older or don’t need to be as active, you might choose not to have surgery. This means you’ll wear a cast or brace and then do exercises to get your leg strong again. This method is safer but might not work as well for everyone.

Choosing between surgery and not having surgery is a big decision. It should be made with the help of a doctor. They will consider what’s best for you based on your situation.

Surgical Management of Achilles Tendon Ruptures

For many, surgical management is the best way to heal from Achilles tendon ruptures. The surgery aims to reconnect the torn tendon and help it heal right. There are two main ways to do this: open surgery and minimally invasive methods.

Open Surgical Repair

Open surgical repair means making a big cut on the back of the ankle. This lets the surgeon see and fix the tear. It’s strong but might lead to more wound problems than the other method. It’s often used for long-standing ruptures or big gaps in the tendon.

Minimally Invasive Surgical Techniques

Minimally invasive surgery is becoming more popular for new tendon ruptures. It uses small cuts and special tools to fix the tendon. It might lead to fewer wound issues and quicker healing. But, some studies say it might be more likely to break again.

Choosing between open and minimally invasive surgery depends on several things. These include the type and age of the rupture, the surgeon’s skill, and what the patient wants. Here’s a look at some key differences:

Postoperative Care and Rehabilitation

Good postoperative care and rehab are key for healing. Right after surgery, the ankle is kept in a cast or boot. Over time, patients start to move their ankle and walk again with help from a physical therapist. They start strengthening exercises around 3 months later. Sports and high-impact activities can return by 6-9 months if everything heals well.

Non-Surgical Treatment of Achilles Tendon Ruptures

For some, non-surgical treatments are an option for Achilles tendon ruptures. This is for older people, those who are less active, or those with health issues that make surgery risky. This method involves keeping the leg immobile to help the tendon heal on its own.

Casting and Immobilization

One way to treat it non-surgically is by using a cast or splint. This keeps the foot pointed, helping the tendon ends come together for healing. The leg stays in this position for several weeks. Over time, the cast may change to allow for walking.

Benefits of this method include:

Functional Bracing

Functional bracing is another non-surgical choice. It uses a special brace that lets the ankle move a bit while supporting the tendon. The brace can be adjusted to help the tendon heal while allowing more ankle movement.

Benefits of functional bracing include:

• It lets you start walking and moving sooner than a cast
• It helps the tendon heal in the right position
• It might prevent muscle loss and joint stiffness from being too long in one position

But, non-surgical treatments might have a higher chance of the tendon rupturing again. It’s key to talk to a doctor about the risks and benefits. They can help decide the best treatment for you.

Rehabilitation and Physical Therapy for Achilles Tendon Ruptures

After an Achilles tendon rupture, whether treated surgically or non-surgically, rehabilitation and physical therapy are key. They help regain strength, flexibility, and function in the affected leg. A licensed physical therapist designs a rehabilitation program. It includes range of motion exercises, strengthening exercises, and a gradual return to activity.

Range of Motion Exercises

In the early stages, the focus is on gently restoring ankle joint range of motion. These exercises may include:

• Ankle pumps
• Gentle ankle circles
• Towel stretches
• Calf stretches

As healing progresses, more advanced exercises are introduced. They help improve flexibility and prevent stiffness.

Strengthening Exercises

Once range of motion is restored, strengthening exercises are introduced. They help rebuild muscle strength and endurance in the calf muscles. Examples include:

Gradual Return to Activity

As strength and function improve, a physical therapist guides the patient back to normal activities. This may include:

• Walking without assistance
• Jogging and running
• Sport-specific drills and exercises
• Plyometric exercises to improve power and agility

The time it takes to return to full activity varies. It depends on individual factors and the rehabilitation protocol. Generally, it takes several months of dedicated rehabilitation. Close communication between the patient, physical therapist, and treating physician is essential throughout the process.

Preventing Achilles Tendon Ruptures

Preventing Achilles tendon ruptures is key for athletes and those who stay active. Stretching the calf muscles helps keep them flexible and lowers injury risk. Try the standing calf stretch and the wall stretch daily. Hold each for 15-30 seconds and do 3-5 times on each leg.

Slowly increase the intensity and time of your workouts to prevent tendon strain. Avoid sudden jumps in training. Instead, follow a gradual program that lets your body adjust.

Wearing the right shoes is also important. Choose ones that support and cushion your feet for your activity. Replace old shoes to keep your feet safe. If you have foot issues, use custom orthotics to help your feet stay aligned.

By stretching, gradually increasing your activity, and wearing the right shoes, you can lower your risk of tendon ruptures. Always listen to your body and rest enough between workouts. This lets your tissues heal and get stronger.