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SONO case series: point-of-care ultrasound for Achilles tendon injury
  1. Emily Neill1,
  2. William Shyy2
  1. 1 Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2 Emergency Medicine, University of California Los Angeles, Los Angeles, CA, USA
  1. Correspondence to Dr Emily Neill, Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, USA; emily.neill{at}

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Case presentation

A 37-year-old man with no significant medical history presents complaints of pain and swelling of his left calf and ankle. Nine days prior to presentation, he felt a popping sensation in his left posterior ankle while pushing off to begin a sprint while exercising. He reports worsening pain and swelling of his left ankle extending into his left calf since the injury.

On examination, the left calf and posterior ankle are swollen and erythematous compared with the contralateral side figure 1. Thompson’s test result is positive on the left side, indicating a rupture of the Achilles tendon. Motor function and sensation are intact, and dorsalis pedis pulses are full in the left foot.

Figure 1

Posterior and lateral views of the patient’s lower leg, showing swelling of the left ankle and calf, and normal lateral view X-ray of the left ankle.

X-rays of the left ankle showed no evidence of fracture or other bony injury.

What are the indications and contraindications for performing point-of-care ultrasound (POCUS) for Achilles tendon injury?

POCUS can be performed in any patient with history and/or physical examination findings concerning Achilles tendon rupture. As with all ultrasound studies, ultrasound for Achilles tendon rupture offers many advantages over other imaging modalities, as it does not require ionising radiation, is rapid to perform as a bedside study and is beneficial for special patient populations that may not tolerate other forms of cross-sectional imaging, such as MRI and CT (eg, paediatric patients). Furthermore, ultrasound is a dynamic imaging modality, allowing for real-time visualisation of tendon movement.

Ultrasound is highly specific and sensitive for the diagnosis of Achilles tendon rupture.1 2 One meta-analysis found that ultrasound had a sensitivity of 95% and a specificity of 99%, with a negative likelihood ratio of 0.05, for the diagnosis of tendon rupture.2 It is also a low-cost, rapid and well-tolerated imaging modality. Finally, unlike MRI, it offers …

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  • Handling editor Simon Carley

  • Contributors EN and WS obtained ultrasound images jointly. EN conducted the primary literature review and authored the primary article. WS edited and provided advice on the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.