By R. Mirsky
POCUS: Following along the tendon from heel to calf (left to right above) reveals a defect in the normal horizontal striations of the tendon indicating a disruption/tear.
A young male presented to the emergency department with right ankle pain and pain with ambulation. On exam, the posterior ankle was tender and edematous. Squeezing his calf muscle reveals minimal plantarflexion (positive Thompson test). MRI of the right ankle was read as a high grade partial or full thickness tear of tendon near its critical zone with scarring.
Pearls: MSK ultrasound is a quick and efficient tool to diagnose tendon/muscle tear. Patients can begin physical therapy or exercises to improve healing prior to confirmatory MRI, which may take a long time to obtain.