Achilles Tendinopathy: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
In general, history and physical exam features are better at ruling in, rather than ruling out achilles tendinopathy. Self reported morning stiffness is the only feature with a moderate negative likelihood ratio. | In general, history and physical exam features are better at ruling in, rather than ruling out achilles tendinopathy. Self reported morning stiffness is the only feature with a moderate negative likelihood ratio. | ||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
! Test ! | !|Test | ||
!|Sensitivity | |||
!|Specificity | |||
!|LR+ | |||
!|LR- | |||
!|Kappa | |||
|- | |- | ||
| | |Palpation (tenderness) | ||
|64% | |||
|81% | |||
|3.15 | |||
|0.48 | |||
|ย | |||
|- | |- | ||
| | |Arc Sign | ||
|42% | |||
|88% | |||
|3.24 | |||
|0.68 | |||
|ย | |||
|- | |- | ||
| | |Royal London Hospital Test | ||
|54% | |||
|86% | |||
|3.84 | |||
|0.54 | |||
|ย | |||
|- | |- | ||
| | |Morning stiffness | ||
|89% | |||
|58% | |||
|2.12 | |||
|0.19 | |||
|ย | |||
|- | |- | ||
| | |Palpation thickening | ||
|59% | |||
|90% | |||
|5.9 | |||
|0.46 | |||
|ย | |||
|- | |- | ||
| | |Crepitus | ||
|3% | |||
|100% | |||
|inf | |||
|0.97 | |||
|ย | |||
|- | |- | ||
| | |Stretch on passive dorsiflexion <br />with knee joint in flexion | ||
|13% | |||
|87% | |||
|1.00 | |||
|1.00 | |||
|ย | |||
|- | |- | ||
| | |Single legged heel raise | ||
|22% | |||
|93% | |||
|3.14 | |||
|0.95 | |||
|ย | |||
|- | |- | ||
| | |Hop test | ||
| | |43% | ||
| | |87% | ||
|3.31 | |||
|0.66 | |||
|ย | |||
|} | |} | ||
{{Template:Ankle Pain DDX}} | {{Template:Ankle Pain DDX}} |
Revision as of 08:36, 20 June 2020
Diagnosis
In general, history and physical exam features are better at ruling in, rather than ruling out achilles tendinopathy. Self reported morning stiffness is the only feature with a moderate negative likelihood ratio.
Test | Sensitivity | Specificity | LR+ | LR- | Kappa |
---|---|---|---|---|---|
Palpation (tenderness) | 64% | 81% | 3.15 | 0.48 | |
Arc Sign | 42% | 88% | 3.24 | 0.68 | |
Royal London Hospital Test | 54% | 86% | 3.84 | 0.54 | |
Morning stiffness | 89% | 58% | 2.12 | 0.19 | |
Palpation thickening | 59% | 90% | 5.9 | 0.46 | |
Crepitus | 3% | 100% | inf | 0.97 | |
Stretch on passive dorsiflexion with knee joint in flexion |
13% | 87% | 1.00 | 1.00 | |
Single legged heel raise | 22% | 93% | 3.14 | 0.95 | |
Hop test | 43% | 87% | 3.31 | 0.66 |
Diffuse
- Ankle (Tibiotalar) Osteoarthritis
- Subtalar Osteoarthritis
- Inflammatory arthropathies - Rheumatoid Arthritis, septic arthritis, osteomyelitis, gout, Osteonecrosis.
- Sarcoid periarthritis
- Benign or malignant neoplasms, myelodysplastic and leukaemic disorders
- Plant-thorn synovitis
- CRPS
Ankle pain persistent following injury
- Fractures - anterior process calcaneus, lateral process talus, posterior process talus (or, rare, os trigonum fracture), osteochondral lesion, tibial plafond chondral lesion, base of fifth metatarsal
- Bony impingements - anterior, posterior, anterolateral
- Atypical sprains - chronic ligamentous instability, medial ligament sprain, syndesmosis sprain (AITFL sprain), subtalar joint sprain
- Tendon injuries - chronic peroneal tendon weakness, peroneal tendon subluxation/rupture, tibialis posterior tendon subluxation/rupture
- Other - inadequate rehabilitation, chronic synovitis, sinus tarsi syndrome
Lateral Ankle Pain
- Peroneal Tendinopathy or recurrent dislocation of peroneal tendons
- Sinus Tarsi Syndrome
- Impingement syndrome (anterolateral, posterior)
- Stress fractures (talus, distal fibula)
- Referred Pain (lumbar, peroneal nerve, superior tibiofibular joint)
- Cuboid Syndrome
- Os Peroneum
- Osteochondritis dissecans (anterior lateral talus)
Medial Ankle Pain
- Tibialis Posterior Tendinopathy
- Flexor Hallucis Longus Tendinopathy
- Medial Calcaneal Nerve Entrapment
- Stress fracture (calcaneal, talar, medial malleolar, navicular)
- Tarsal Tunnel Syndrome
- Posterior Ankle Impingement
- Referred Pain from the lumbar spine
- Complications of acute ankle injuries
- Os tibiale externum (accessory navicular)
- Osteochondritis dissecans (posterior medial talus)
Posterior Ankle Pain
- Midportion Achilles Tendinopathy
- Insertional Achilles Tendinopathy
- Retrocalcaneal bursitis
- Paratenon inflammation
- Posterior impingement syndrome
- Plantaris Tendinopathy
- Sever Disease (Calcaneal Apophysitis)
- Accessory or low soleus muscle
- Referred Pain (neural structures, lumbar spine), and sural neuropathy
- Achilles tendon rupture
- Achilles enthesopathy due to inflammatory arthropathies
- Osteochondritis dissecans (posterior medial talus)