Professional Documents
Culture Documents
Akut Neglected
1. Accidental cut injury (bath room
injury, road traffic injury)
2. Social/political Violence
1. Diagnosis and assessment of extend of injury.
2. Primary care
3. Operative treatment
Pathophysiology
• Repetitive microtrauma in a
relatively hypovascular area.
• Reparative process unable
to keep up
• May be on the background
of a degenerative tendon
• 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 4 cm proximal to the
calcaneal insertion.
Anamnesis
• Gerakan tiba tiba di belakang kaki
• Sensasi robekan kadang terdengar dibelakang tumit. Biasanya
pasien sering dilaporkan melihat berkeliling untuk mencari
siapa yang memukul belakang tumitnya, lalu merasa nyeri dan
jatuh tiba – tiba.
• Riw. Penggunaan fluoroquinolone, steroid injections
Mechanism
• plantarflexi kuat dari kaki dan
pergelangan kaki (squash, badminton,
sepak bola, tennis, volli)
• Eccentric loading (running backwards in
tennis)
• Sudden unexpected dorsiflexion of ankle
• (Direct blow or laceration)
Ruptured Tendon
Normal TA not
Visible/Palpable
• 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, gap tendon, hematom
• Partial
• Localized tenderness +/-
nodularity
• Complete
• Defect
• Cannot heel raise
• Positive Thompson test
• 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
This lateral x-ray of
the calcaneus
shows an avulsion
fracture at the
insertion of the
Achilles tendon, with
marked separation
of fragments.
.
Ultrasound
• Inexpensive, fast, reproducable,
dynamic examination possible
• Operator dependent
• Best to measure thickness and
gap
• Good screening test for
complete rupture
• Expensive, not dynamic
• Better at detecting partial
ruptures and staging
degenerative changes,
(monitor healing)
Diferensial diagnosis
1. Robekan incomplete, jika rupture complete tidak tampak
dalam 24 jam, gap sulit diraba. Pasien masih bisa jinjit
sejenak menggunakan flexor panjang jempol kaki.
2. Robekan muskculus soleus, robekan pada batas
muskulotendineus menyebabkan nyeri dan nyeri tekan pada
pertengahan atas betis. Ini bisa sembuh sendiri dengan
fisioterapi dan meninggikan tumit sepatu.
• Restore musculotendinous length and
tension.
• Optimize gastro-soleous strength and
function
• Avoid ankle stiffness
CAM Walker or cast with
2 wks plantarflexion q 2 wks
4 weeks
112 patients