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Achilles tendon injuries are commonly encountered in the emergency department. While MRIs are often unavailable, POCUS offers a quick and effective alternative for evaluating such injuries. In one review, the sensitivity of ultrasound for detecting complete Achilles tendon ruptures was 94.8%.
For the POCUS evaluation of the Achilles tendon:
- Place the patient in a prone position with their foot relaxed.
-Begin distally at the tendon’s insertion on the calcaneus and scan proximally, keeping the probe marker oriented toward the patient’s head.
-Next, obtain a transverse view by rotating the probe marker toward the patient’s right side.
-You can even do a sonographic Thompson’s Test!
Findings:
Complete Rupture: Displays as a full disruption of the tendon fibers.
Partial Tear: Shows intact tendon tissue with surrounding edema.
Tendinitis: Appears as a thickened tendon with increased vascularity on color Doppler imaging.
References
Aminlari A, Stone J, McKee R, Subramony R, Nadolski A, Tolia V, Hayden SR. Diagnosing Achilles Tendon Rupture with Ultrasound in Patients Treated Surgically: A Systematic Review and Meta-Analysis. J Emerg Med. 2021 Nov;61(5):558-567. doi: 10.1016/j.jemermed.2021.09.008.