Thompson Test

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 Thompson Test


What is Thompson Test?

Thompson Test (or as it called Calf Compression Test or Simmonds’ test) is used to identify the presence of a complete Achilles tendon rupture.

Thompson test was first described by Franklin Adin Simmonds (1911-1983), an English Orthopedic Surgeon at the Rowley Bristow Hospital, Surrey. 1

See Also: Ankle Anatomy

How do you perform Thompson test?

What does a positive Thompson Test mean?

Compressing the calf muscles should normally provoke rapid passive plantar flexion of the foot.

Thompson Test
Negative & Positive Thompson Test

Thompson Test Accuracy

Thompson Test has a high Sensitivity and Specificity according to one study by Maffulli 23 as following:

Notes

To make sure that the Achilles tendons is torn, look for these clinical signs that can be seen to confirm the diagnosis:

  1. With the patient prone, and ankle relaxed , the foot on the affected side hangs straight down because of the absence of the tendon tone.
  2. A palpable gab can be felt in the Achilles tendon, about 3-6 cm proximal to its insertion onto the calcaneus.
  3. The strength of the plantar flexion is reduced compared to the other side.

Other Achilles Tendon Tests

Matles Test

Matles Test is another special test that is used for Achilles Tendon Rupture.

The patient lies in the prone position with the foot over the end of the table and the clinician stands at the end of the table.

The patient is asked to actively flex the knee to 90 degrees while the position of the foot is observed throughout the motion.

If the foot falls into neutral or slight dorsiflexion, the Matles Test test is positive for Achilles tendon rupture (in normal patients, the foot remains in plantar flexion).

Maffulli found this test to have a Sensitivity of 0.88, a Specificity of 0.85, and a positive predictive value of 0.92.

Matles Test
Matles Test

Hoffa Sign

Hoffa Sign indicates a chronic Achilles tendon tear.
The patient is prone with the feet projecting over the edge of the examining table. The examiner passively dorsi flexes both feet.

In a chronic Achilles tendon tear, tension in the Achilles tendon will be reduced and the affected foot can be dorsi flexed farther than the contralateral foot. The patient is then requested to stand on tiptoe on each leg. This will be impossible with an Achilles tendon tear in the injured leg.

Hoffa Sign

Achilles Tendon Tap Test

Achilles Tendon Tap Test indicates an Achilles tendon tear.

The patient is prone with the knee flexed 90°. The examiner taps the distal third of the Achilles tendon with a reflex hammer.

Increased pain and loss of plantar flexion (Achilles tendon reflex) are signs of a tear in the Achilles tendon. In the absence of an Achilles tendon reflex, a differential diagnosis should exclude neurologic changes.

Achilles Tendon Tap Test
MuscleOriginInsertionActionInnervation
GastrocnemiusPosterior medial and lateral femoral condylesCalcaneusPlantar flexing footTibial (S1) nerve
SoleusFibula/tibiaCalcaneusPlantar flexing footTibial (S1) nerve
PlantarisLateral femoral condyleCalcaneusPlantar flexing footTibial (S1) nerve
Superficial Posterior Compartment of the Leg

Rupture of the Achilles Tendon

Rupture of the Achilles tendon was first described in 1575, and first reported in the literature in 1633.

Although the etiology of a spontaneous rupture remains incompletely understood, a number of theories have been proposed, including:

  1. microtrauma,
  2. inhibitor mechanism malfunction,
  3. hypoxic and mucoid tendon degeneration,
  4. decreased perfusion,
  5. systemic or locally injected steroids.

However, the fact that the peak incidence of Achilles, tendon rupture occurs in the middle age group rather than in the older population tends to lend credence to a mechanical etiology.

Three specific activities have been implicated in rupturing the Achilles tendon:

  1. Pushing off on the forefoot while extending the knee.
  2. Sudden dorsiflexion with full-weight-bearing as might occur with a slip or fall.
  3. Aggressive dorsiflexion such as that occurs when jumping or falling from a height and landing on a plantar flexed foot.

The diagnosis of an Achilles tendon rupture is based almost solely on the history and physical findings:

Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches, although opinions are divided as to what is the best course of action:

References

  1. Simmonds FA (1957). “The diagnosis of the ruptured Achilles tendon”. The Practitioner. 179 (1069): 56–8. PMID 13453094.
  2. Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med. 1998 Mar-Apr;26(2):266-70. doi: 10.1177/03635465980260021801. PMID: 9548122.
  3. Chad Cook, Pt, Phd, Mba. “Diagnostic Accuracy Of Physical Examination Tests Of The Ankle/Foot Complex: A Systematic Review”. Sports Physical Therapy Section 2013 Aug; 8(4): 416–426. Pmcid: Pmc3812842.
  4. Lea RB, Smith L. Non-surgical treatment of tendo achillis rupture. J Bone Joint Surg Am. 1972 Oct;54(7):1398-407. PMID: 4655535.
  5. Nistor L. Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg Am. 1981 Mar;63(3):394-9. PMID: 7204438.
  6. Metz R, van der Heijden GJ, Verleisdonk EJ, Tamminga R, van der Werken C. Recovery of calf muscle strength following acute achilles tendon rupture treatment: a comparison between minimally invasive surgery and conservative treatment. Foot Ankle Spec. 2009 Oct;2(5):219-26. doi: 10.1177/1938640009348338. Epub 2009 Sep 4. PMID: 19825777.
  7. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. Epub 2010 Oct 29. PMID: 21037028.
  8. Reiman M, Burgi C, Strube E, Prue K, Ray K, Elliott A, Goode A. The utility of clinical measures for the diagnosis of achilles tendon injuries: a systematic review with meta-analysis. J Athl Train. 2014 Nov-Dec;49(6):820-9. doi: 10.4085/1062-6050-49.3.36. PMID: 25243736; PMCID: PMC4264655.
  9. Figliuzzi A, Alvarez R, Al-Dhahir MA. Achilles Reflex. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459229/
  10. Clinical Tests for the Musculoskeletal System 3rd Edition.
  11. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.




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