The Emergency Room and the Ultrasound

Having recently sat through numerous “lower extremity” lectures, it didn’t take long for me to suspect that my injury was more than a simple strain. I couldn’t forcefully point my toes or flex my calf. At roughly 11pm, 4 hours post injury, I decided it was worth a trip to the ER. If nothing else I would get piece of mind, a walking boot, and a reason to postpone a quiz that I wasn’t quite prepared for. I hobbled my way to the car and drove the half mile, knee locked, to the hospital. My school is in a small town and the hospital is tiny, so there was no wait. After filling out some forms it wasn’t more than 15 minutes before I saw a nurse and physician. The physician was quick, poked around the tendon near the insertion on my heal, and told me he thinks it was a “bad strain”. It’s hard to blame him as my rupture was high up so through the swelling you could still feel an in tact tendon near the heal. I had recently learned about the Thompson Test, but was too excited that it wasn’t ruptured to press him for more information. I did ask for a walking boot so I could attend anatomy lab in the morning. He obliged, gave me a boot, some crutches, and a note to see an orthopedist if it was still bothering me in seven days. As I’m writing a post on “Achilles Blog”, you can pretty well guess that it didn’t improve over the next seven days.

My injury and ER visit was on a Thursday. That weekend, with the boot strapped on, I limped around, cooked, studied, enjoyed a glass or six of wine, and waited for the swelling to subside. It was Tuesday, while participating in an ultrasound lab, that I realized the physician in the ER was dead wrong. We were learning to perform ultrasounds on the upper extremities, shoulder, rotator cuff, etc, and I decided to have a teaching fellow help me ultrasound my Achilles’. I’ll spare you the medical jargon and leave it at this: It was clear something wasn’t right. I scheduled an appointment with an orthopedist for the following day.

In retrospect I should’ve known something wasn’t right in the ER but as I wrote earlier, I was damn excited that it “wasn’t ruptured”. Your best intentions, hopes, and excitement can often get in the way of the truth. Trust your intuition and always push your doc to dig deeper and explore further. This injury isn’t a strain and it’s not a sprain. Some people are in excruciating pain, others, like me, little to no pain. The bottom line however, is that if you can’t forcefully flex your calf and point your toes, something is wrong. Give it the old trash can test: Find a trash can with a foot pedal that opens the lid. If you can’t operate it easily and without pain, schedule an appointment with a physician and ask for the Thompson Test. Better yet, watch a 3 minute youtube video and have a friend or family member perform the Thompson Test on you. As far as diagnostic tests for Achilles’ dysfunction, it’s as definitive as they come.

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