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Tendon injuries - part 7

Kiểm tra lâm sàng là công cụ chẩn đoán tốt nhất. Cả hai chân được tiếp xúc từ phía trên đầu gối và các bệnh nhân kiểm tra trong khi đứng và prone.The chân và gót chân nên được kiểm tra cho malalignment bất kỳ, biến dạng, rõ ràng không đối xứng trong gân, kích thước dày địa phương | 21. Achilles Tendinopathy 203 Figure 21-2. Typical nodule in Achilles tendinopathy. It is easily appreciated with the patient prone and is located 2-6 cm proximal to the tendon insertion on the calcaneum. Figure 21-3. Preoperative ultrasound scan of the patient whose histological appearance is shown in Figure 21-1. Note the widening of the Achilles tendon and the intratendinous disorganization. Clinical examination is the best diagnostic tool. Both legs are exposed from above the knees and the patient examined while standing and prone. The foot and the heel should be inspected for any malalignment deformity obvious asymmetry in the tendons size localized thickening Haglund heel and any previous scars see Figure 21-2 . The Achilles tendon should be palpated for tenderness heat thickening nodule and crepitation 4 . The tendons excursion is estimated to determine any tightness. The painful arc sign helps to distinguish between tendon and paratenon lesions. In paratendinopathy the area of maximum thickening and tenderness remains fixed in relation to the malleoli from full dorsi- to plantar flexion whereas lesions within the tendon move with ankle motion 33 . There is often a discrete nodule whose tenderness significantly decreases or disappears when the tendon is put under tension 28 34 . Imaging Although plain soft tissue radiography is no longer the imaging modality of choice in tendon disorders it still has a role in diagnosing associated or incidental bony abnormalities. Magnetic resonance imaging MRI provides extensive information about the internal morphology of tendon and the external anatomy. It is a useful tool to evaluate the various stages of chronic degeneration and differentiation between paratendinopathy and tendinopathy of the main body of the tendon. Areas of mucoid degeneration in the Achilles tendon are shown at MRI as high signal intensity zone on T1 and T2 weighted images. MRI is superior to ultrasound US in detecting incomplete tendon rupture 35 .