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Thompson Test in Achilles Tendon Rupture

Spencer Albertson* and Megan Boysen Osborn, MD, MHPE*

*University of California, Irvine, Department of Emergency Medicine, Orange, CA

Correspondence should be addressed to Megan Boysen Osborn, MD, MHPE at mbo@uci.edu

DOI: https://doi.org/10.21980/J8VC7SIssue 1:1
OrthopedicsTraumaVisual EM
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HPI:

A 26-year old male presented to the emergency department after experiencing the acute onset of left ankle pain while playing basketball. Upon jumping, he felt a “pop” in his left posterior ankle, followed by pain and difficulty ambulating. His exam was notable for a defect at the left Achilles tendon on palpation. The practitioner performed a Thompson test, which was positive (abnormal) on the left.

Significant Findings:

The left Achilles tendon had a defect on palpation, while the right Achilles tendon was intact. When squeezing  the  right  (unaffected)  calf,  the  ankle spontaneously plantar flexed, indicating a negative (normal) Thompson test. Upon squeeze of the left (affected) calf, the ankle did not plantar flex, signifying  a  positive  (abnormal)  Thompson  test. The diagnosis of left Achilles tendon rupture was confirmed intraoperatively one week later.

Discussion:

The Achilles tendon (also: calcaneal tendon or heel cord) is derived from the medial and lateral heads of the gastrocnemius muscle, as well as the soleus muscle. Rupture of the Achilles tendon most commonly occurs in the distal tendon, approximately 2-6 cm from its attachment to the calcaneal tuberosity, in an area of hypovascularity known as the “watershed” or “critical” zone.1-3 The Thompson test (also: Simmonds-Thompson test), described by Simmonds in 1957 and Thompson in 1962, is done while the patient is in the prone position, with feet hanging over the end of a table/gurney, or with the patient kneeling on a stool or chair.4-5 Squeezing the calf of an unaffected limb will cause the ankle to plantar flex, but squeezing the calf of a limb with an Achilles tendon rupture will cause no motion. The sensitivity of the Thompson’s test for the diagnosis of a complete Achilles tendon rupture is 96-100% and the specificity is 93-100%, but data is limited.6-8

Topics:

Thompson test, Simmonds-Thompson test, orthopedics, Achilles tendon rupture, calcanea tendon rupture, ankle pain, calf pain.

References:

  1. Lagergren C, Lindholm A. Vascular distribution in the Achilles tendon: an angiographic and microangiographic study. Acta Chir Scand. 1959;116(5-6):491–495.
  2. Hastad K, Larsson L, Lindholm A. Clearance of radiosodium after local deposit in the Achilles tendon. Acta Chir Scand. 1959;116(3):251–255.
  3. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 2000;175(3):613-625. doi: 10.2214/ajr.175.3.1750613
  4. Thompson TC. A test for rupture of the tendon Achilles. Acta Orthopaedica Scandinavica. 1962;23:461-465.
  5. Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957;179:56-58.
  6. Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H. MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res. 2012;470(8):2268-2273. doi: 10.1007/s11999-012-2355-y
  7. Schwieterman B, Haas D, Columber K, Knupp D, Cook C. Diagnostic accuracy of physical examination tests of the ankle/foot complex: asystematic review. Int J Sports Phys Ther. 2013;8(4):416-426.
  8. Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. Am J Sports Med. 1998;26(2):266–270. doi: 10.1177/03635465980260021801
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