|
Cases
Sudden Ankle Pain During a Basketball Game
| |
Case
A
middle-aged man presents to the emergency department after
hearing a pop while playing basketball. What classic sign is
present? Name the injury and explain its management.
|
|
Scroll
down for Hint and Answer
|
|
|
***** HINT *****
Look where the finger is pointing. Patients with this injury may delay seeking
medical care because their initial symptoms may be limited to weakness that
occurs with a push-off movement. Pain, edema, and ecchymosis may follow.
***** ANSWER *****
Achilles tendon
rupture is caused by sudden dorsiflexion when a person runs with his or her knee
extended. A direct blow to the Achilles tendon while the gastrocnemius and
soleus muscles are contracted also may result in rupture. Ruptures usually occur
2-6 cm proximal to the insertion point because the poor blood supply is poorest
in this area, with resultant degeneration. The photo illustrates palpation of
the defect with the patient prone and the affected foot hanging over the edge of
the bed. The result of the Thompson test is positive, that is, no plantar
flexion when the gastrocnemius muscle is squeezed. Rest, ice, compression, and
elevation (RICE) should be the initial therapy in the emergency department.
Partial tears are managed with posterior splints and crutches and with no weight
bearing. Surgical repair has a lower re-rupture rate (2%) than nonsurgical
casting (10-25%), but both require 6 weeks of immobilization, followed by 5
weeks of protected weight bearing and 6 months of rehabilitation. Reference:
Tintinalli JE, Krome RL, eds. In: Emergency Medicine: A Comprehensive Study
Guide. 4th ed. 1995:1302.
|
Author:
David Zull, MD
Northwestern University
Editor:
John Leung, MD
Yale University- Yale New Haven Hospital
Source
http://emedicine.com
|
|
