Recently seen: patient (50) with 6 weeks old Achilles tendon rupture; diagnosed with the Thompson test (sensitivity and specificity above 0.9); no imaging additional diagnostics. Treatment gypsum; after 6 weeks the patient is again walking, gently without an aid. Question of the patient: ‘what is the status of my AP with ultrasound at the moment?’
The not perfect sticking and cutting of the undersigned you can see on the picture above 🙂
On the picture – near the arrow – on the left, a rupture in the tendon of the lateral and medial head of the gastrocnemius; near the arrow on the right a full-thickness rupture of the AP. The Kagerian fat is intact on this sagittal cut. The tear in the AP at the level of the musculotendinogenous transition shows hardly any retraction, possibly ‘curling fibres’, the fibrillary pattern is disturbed. The area shows signs of hypervascularization (not in this image). Finally: the AP is thickened over its entire length so there is also tendinopathy.
This case is surprising in that sense because (initially) ‘one’ rupture ‘somewhere’ in the AP was thought, size unknown, condition paratenon unknown, status Kagerian fat unknown. These are all things that can influence recovery and the choice of whether or not to operate. This super sportive patient of 50 years of age did not make this assessment, he was ‘standard’ plastered in …
In times of corona, everything – which is not directly related to corona – feels as absurdly relative. The writer is aware of this.