TY - JOUR T1 - SONO case series: point-of-care ultrasound for Achilles tendon injury JF - Emergency Medicine Journal JO - Emerg Med J DO - 10.1136/emermed-2022-212665 SP - emermed-2022-212665 AU - Emily Neill AU - William Shyy Y1 - 2023/03/17 UR - http://emj.bmj.com/content/early/2023/03/16/emermed-2022-212665.abstract N2 - 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.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 … ER -