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Achilles tendon rupture

Right ankle joint pain during movement, twisted two months ago.

Patient Data
AGE: 55 years
GENDER: Female

[Image: IMG-0194-00020_big_gallery.jpeg]
Coronal STIR

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Coronal T1

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Sagittal PD fat sat

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Sagittal T1

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Axial T1 fat sat

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Axial PD fat sat

Diffuse degenerative changes with a complete rupture of the Achilles tendon are noted associated with tendon retraction. 
Mild degenerative changes are noted tibiotalar joint.  
Sinus tarsi slightly infiltrated.  
Mild fluid signal is noted around the fibularis longus and brevis tendons suggesting tenosynovitis.  
Retro-calcaneal bony spur is present.  
Diffuse inflammatory changes are visualized surrounding the right ankle joint.  
Lateral and medial malleolus are unremarkable.  

Case Discussion
Features of Achilles tendon rupture, tenosynovitis of the fibularis longus and brevis tendons.

Achilles tendon tears are the most common ankle tendon injuries, with microtears to full thickness tendon tears of the Achilles tendon and are most commonly seen secondary to sports-related injury, especially squash and basketball.

Clinical presentation
Typically patients present with sudden onset of pain and swelling in the Achilles region, often accompanied by an audible snap during forceful dorsiflexion of the foot. A classic example is that of an unfit 'weekend warrior' playing squash.  

If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance. 

1. Kleinman M, Gross AE. Achilles tendon rupture following steroid injection. Report of three cases. J Bone Joint Surg Am. 1983;65 (9): 1345-7. J Bone Joint Surg Am (pdf) - Pubmed citation
2. Hartgerink P, Fessell DP, Jacobson JA et-al. Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology. 2001;220 (2): 406-12. Radiology (full text) - Pubmed citation
3. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 2000;175 (3): 613-25. AJR Am J Roentgenol (full text) - Pubmed citation
4. Manoj kumar RV, Rajasekaran S. Spontaneous tendon ruptures in alkaptonuria. J Bone Joint Surg Br. 2003;85 (6): 883-6. J Bone Joint Surg Br (link) - Pubmed citation
5. Jamadar DA, Jacobson JA, Theisen SE et-al. Sonography of the painful calf: differential considerations. AJR Am J Roentgenol. 2002;179 (3): 709-16. AJR Am J Roentgenol (full text) - Pubmed citation
6. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 2000;175 (3): 613-25. doi:10.2214/ajr.175.3.1750613 - Pubmed citation

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