History and Physical Examination
In the absence of reliable evidence, it is the opinion of this work group that a detailed history and physical exam be performed. The physical examination should include two or more of the following tests to establish the diagnosis of acute Achilles tendon rupture:
(1) Clinical Thompson test (Simmonds squeeze test)
(2) Decreased ankle plantar flexion strength
(3) Presence of a palpable gap (defect, loss of contour)
(4) Increased passive ankle dorsiflexion with gentle manipulation
(1) Clinical Thompson test (Simmonds squeeze test)
(2) Decreased ankle plantar flexion strength
(3) Presence of a palpable gap (defect, loss of contour)
(4) Increased passive ankle dorsiflexion with gentle manipulation
CONSENSUS RECOMMENDATION Rationale
A systematic review of the literature did not identify adequate evidence for or against the use of specific history and physical examination findings to confirm the diagnosis of acute Achilles tendon rupture. There was only one level V study16 identified that did not provide adequate data in support of any individual or combination of the physical tests.
The prompt and accurate diagnosis of acute Achilles tendon rupture is essential to providing patients with timely, effective, and appropriate care. A history and physical examination adds no cost or risk to patients. The work group therefore agreed that an opinion-based recommendation is warranted.
The prompt and accurate diagnosis of acute Achilles tendon rupture is essential to providing patients with timely, effective, and appropriate care. A history and physical examination adds no cost or risk to patients. The work group therefore agreed that an opinion-based recommendation is warranted.