tommyk
05-16-2006, 07:23 PM
Hy 2218
An obese 50-year-old man is trying to play a hard game of rugby. In the middle of the game, a loud "pop" (like a gunshot) is heard, and the man falls to the ground clutching his ankle. He limps off the court with pain and swelling in the back of the lower leg. Although he can still weakly plantar-flex his foot, he seeks medical help the next day because of persistent pain, swelling, and limping. He can put weight on that foot with no exacerbation of the pain, but the motion of taking a step is painful. Which of the following would be the most likely finding on physical examination?
1- Tapping on the calcaneus is extremely painful
2- The ankle joint can be abducted farther out than the normal contralateral side
3- The ankle joint can be adducted farther in than the normal contralateral side
4- There is a gap in the Achilles tendon easily felt by palpation
5- There is crepitation and grating by direct palpation over either malleoli.
6- A fracture of the taleus bone on plain film
The clinical description is that of a rupture of the Achilles tendon. The injured structure is so close to the skin that direct palpation of the gap in the tendon is usually possible. A fracture of the calcaneus would happen with a fall from a height, landing on one's feet.The ability to bend a joint beyond the normal boundaries implies damage to the ligaments that keep that joint tight. However such damage would not produce the loud popping noise so characteristic of rupture of the Achilles tendon. Grating and crepitation are findings that indicate bony fracture; if these were present, the patient would not be able to put weight on the injured side.
An obese 50-year-old man is trying to play a hard game of rugby. In the middle of the game, a loud "pop" (like a gunshot) is heard, and the man falls to the ground clutching his ankle. He limps off the court with pain and swelling in the back of the lower leg. Although he can still weakly plantar-flex his foot, he seeks medical help the next day because of persistent pain, swelling, and limping. He can put weight on that foot with no exacerbation of the pain, but the motion of taking a step is painful. Which of the following would be the most likely finding on physical examination?
1- Tapping on the calcaneus is extremely painful
2- The ankle joint can be abducted farther out than the normal contralateral side
3- The ankle joint can be adducted farther in than the normal contralateral side
4- There is a gap in the Achilles tendon easily felt by palpation
5- There is crepitation and grating by direct palpation over either malleoli.
6- A fracture of the taleus bone on plain film
The clinical description is that of a rupture of the Achilles tendon. The injured structure is so close to the skin that direct palpation of the gap in the tendon is usually possible. A fracture of the calcaneus would happen with a fall from a height, landing on one's feet.The ability to bend a joint beyond the normal boundaries implies damage to the ligaments that keep that joint tight. However such damage would not produce the loud popping noise so characteristic of rupture of the Achilles tendon. Grating and crepitation are findings that indicate bony fracture; if these were present, the patient would not be able to put weight on the injured side.