Your SlideShare is downloading. ×
0
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Achilles tendon for presentation
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Achilles tendon for presentation

4,044

Published on

CME- on Tendo Achillis Injury

CME- on Tendo Achillis Injury

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
4,044
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
161
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1.  Largest tendon in the body Origin from gastrocnemius and soleus muscles Insertion on calcanealtuberosity
  • 2. Lacks a true synovial sheath- Paratenon has visceral and parietal layers Allows for 1.5cm of tendon glide
  • 3. Paratenon  Anterior – richly vascularized  The remainder – multiple thin membranes
  • 4. Blood supply1) Musculotendinous junction2) Osseous insertion on calcaneus3) Multiple mesotenal vessels on anterior surface of paratenon (in adipose) – Transverse vincula  Fewest @ 2 to 6 cm proximal to osseous insertion
  • 5.  Remarkable response to stress  Exercise induces tendon diameter increase  Inactivity or immobilization causes rapid atrophy Age-related decreases in cell density, collagen fibril diameter and density  Older athletes have higher injury susceptibility
  • 6.  Gastrocnemius-soleus-Achilles complex  Spans 3 joints  Flex knee  Plantar flex tibiotalar joint  Supinatesubtalar joint Up to 10 times body weight through tendon when running
  • 7. 1. Close injury/rupture2. Open injury/rupture • Acute injury • Neglected injury
  • 8. 1. Accidental cut injury (bath room injury, road traffic injury)2. Social/political Violence
  • 9. 1. Diagnosis andassessment of extendof injury.2. Primary care3. Operative treatment
  • 10.  Pathophysiology  Repetitive microtrauma in a relatively hypovascular area.  Reparative process unable to keep up  May be on the background of a degenerative tendon
  • 11.  Antecedent tendinitis/tendinosis in 15% 75% of sports-related ruptures happen in patients between 30-40 years of age. Most ruptures occur in watershed area 4cm proximal to the calcaneal insertion.
  • 12. History Feels like being kicked in the leg Case reports of fluoroquinolone use, steroid injections Mechanism  Eccentric loading (running backwards in tennis)  Sudden unexpected dorsiflexion of ankle  (Direct blow or laceration)
  • 13. Prone patient with feet over edge of bedPalpation of entire length of muscle- tendon unit during active and passive ROMCompare tendon width to other sideNote tenderness, crepitation, warmth, swelling, nodularity, palpable defects
  • 14.  Partial Localized tenderness +/- nodularity Complete Defect Cannot heel raise Positive Thompson test
  • 15.  Diagnostic Pitfalls 23% missed by Primary Physician (Inglis&Sculco)  Tendon defect can be masked by hematoma  Plantar-flexion power of extrinsic foot flexors retained  Thompson test can produce a false-negative if accessory ankle flexors also squeezed
  • 16. This lateral x-ray of thecalcaneus shows anavulsion fracture at theinsertion of the Achillestendon, with markedseparation of fragments..
  • 17.  Inexpensive, fast, reproducable, dynamic examination possible Operator dependent Best to measure thickness and gap Good screening test for complete rupture
  • 18.  Expensive, not dynamic Better at detecting partial ruptures and staging degenerative changes, (monitor healing)
  • 19.  Restore musculotendinous length and tension. Optimize gastro-soleous strength and function Avoid ankle stiffness
  • 20. CAM Walker or cast with 2 wks plantarflexion q 2 wks 4 weeksStart physio for ROM Allow progressive weight-exercises bearing in removable cast When WBAT and 2- 4 weeks foot is plantigradeStart a strengthening Remove cast and walk with shoeprogram lift. Start with 2cm x 1 month, then 1cm x1 month then D/C
  • 21.  Preserve anterior paratenon blood supply Beware of sural nerve Debride and approximate tendon ends Use 2-4 stranded locked suture technique May augment with absorbable suture Close paratenon separately
  • 22.  Acute case : usually end to end repair is enough Neglected case: Advancement plasy (V-Y) or reconstruction by other tendons
  • 23.  Assess strength of repair, tension and ROM intra-op. Apply long leg cast with ankle in the least amount of planterflexion(gravityequinus) & knee 60 degree flexion with window at operated site. Stitch removal after 2 wks. Short leg cast after 3 wks with partial equinus correction
  • 24.  2 weekly plaster change with gradual equinus correction (4-6 episode ). Walking with heel raised shoe & regular physiotherapy. Reverse ankle stop brace up to 6 months.
  • 25. Acute rupture of tendon Achilles. A prospective randomised study ofcomparison between surgical and non-surgical treatment. Moller M, et al. J Bone Joint Surg Br. 2001 Aug;83(5):863-8 112 patientsCasted x 8 wks Surgery + Early functional rehab in brace21 % re-rupture 1.7% re-rupture 5% infection No difference in functional outcome 2% Sural nerve inj.

×