Thompson Test…Always

So exactly 1 week post rupture, one week of limping around campus in a boot set to neutral flexion, I went to my appointment with the orthopedic surgeon. Within 1 minute he diagnosed an Achilles’ rupture. It’s literally that easy. Had me kneel on a chair, squeezed my good calf then my bad. I distinctly remember dropping a four letter word after he squeezed the right calf and pointed out the deficit to his resident.

Knowing that surgery would mean 2-3 weeks on my back and likely dropping out of school for the semester I explained to the doc that I was resigned to treating the rupture conservatively. He told me to make an appointment for an MRI then we could discuss treatment. By virtue of having a professor that owns and operates an outpatient MRI I was able to schedule an MRI within a few days. As an aside, an MRI is truly not required or necessary to diagnose a ruptured Achilles’. As I’ve stressed, Thompson, Thompson, Thompson. If you are interested in conservative (non-surgical) treatment, an MRI will help your physician determine if this is a suitable route. I’m only a first year med student, so I won’t pretend to know the ins and outs of the Achilles’ protocol, but from my research and common sense I would imagine that there is a point at which the tendon may be separated far enough from the other end that conservative treatment is not advised. When your insurance inevitably tries to foot you with the MRI bill, kindly remind them that if you choose the conservative route you will be saving them a considerable sum.

So…I got the MRI. It took about 45 minutes and I got to listen to The Beatles through the whole thing. My professor, hell of a guy and hell of a doctor, brought me into his office to review the images. He showed me where the rupture was (a few inches below my calf muscle) and explained that while there may be a few threads hanging on, for all intents and purposes it was a full rupture. He performed another ultrasound so he could show me exactly how shredded my garbage tendon was. Long story short, full rupture, a ton of shadowing on the ultrasound (shadowing = bad), and a bit of a chuckle when I asked if I would be laid up for “about six weeks”. He assured me the road would be a bit longer.

5 Responses to “Thompson Test…Always”

  1. I’m loving your story! You’re about 3 months now so how are you doing?

  2. Hi Cserpent,

    This weekend was my first full weekend out of the boot. I haven’t had it on since Thursday afternoon. So far so good :)

    I see the doc tomorrow so we will see what he thinks

  3. bruiser, My doc ( a surgeon) suggested surgery was “a better option” but when I pressed him on exactly why, he couldn’t really say much…anyway he agreed to treat me non surgically but he felt no need to image. Maybe he could tell by palpation where the pieces were, I don’t know.
    So, how are you doing? Where are you in the process?

  4. Hi Dan,

    I’m sure imaging isn’t always required to make the conservative call. From my research the factors that play a part are gap distance, distance from insertion (closet to the calf has a better blood supply), and personal preference. I did consult with an orthopedic surgeon friend of mine and he echoed what everyone says; 5-10 years ago surgery was bar-none the way to go but in the past 2-3 years conservative treatment has gained a lot of traction.

    Anyways, fingers crossed I’m doing very well. I’m at around the 12 week point and have been out of the boot for 5 days. I probably could’ve come out a bit earlier but we’ve had some snow and ice and I didn’t want to risk it. The atrophy in my right calf is ridiculous (as I’m sure you know), but the strength is returning every day. I’ve been doing a lot of stationary biking and calf raises among other things. Also made a 6 hour round trip drive two weekends in a row. First trip was dicey, second was much better. I’ve found that if I do my exercises first thing in the morning it’s much easier to get my day started. Really loosens up the tendon. My PT says next step is single leg calf raises, and while I can do 30-40 good raises with both legs, I seem a long way away from doing a single leg. I’m sure it’s more mental than anything else.

    How are you coming along?

  5. I just got back from PT, in fact I’m icing as I type. I’m at 13 1/2 weeks. My PT is very pleased, almost surprisingly so, at my pace of recovery. I think the surprise has more to do with the fact that I’m their first non-surgical case. Hey, somebody has to be first, right?
    I walked 1 1/2 miles on Saturday, and nearly 2 miles on Sunday, with walking sticks. Certainly not full speed, by a long shot, but it really seemed to kick up everything else I can do. Gait is improving. PT was very pleased with my range of motion and strength. No single leg calf raises yet, but am working on doubles, and my one foot balance is getting better every day. We have snow and ice here too, so much of what I’d like to do, like walk and golf, is out of the question anyway. Will be wintering in Florida, starting New Years Weekend, so I’ll be getting back to that next month. I think I could swing fully, but walking around the course would be more difficult. I have 4 more weeks of healing before it’s an option. If I don’t have any setbacks, I think I’ll be able to golf and continue rehabbing in Florida, just fine.

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