Achilles ƒe Ʋuka ƒe Ʋuʋu, Patellar ƒe Ʋuka ƒe Ʋuʋu, kple Afɔ ƒe Dzedze Kpekpeɖeŋu ƒe Triage¶

Gbeɖiɖi sesẽ aɖe si dona le afɔ si le ete ƒe megbe alo klo ƒe ŋgɔgbe le duƒuƒu, titri, alo nukikli me kpata, nye dzesi si wonya nyuie be Achilles ƒe lãkusi ƒe gbagbã alo extensor mechanism (patellar alo quadriceps tendon) ƒe aɖatsi bliboe. Nenema ke ŋutetemanɔamesi kpata be woakɔ afɔ kple afɔbidɛwo ɖe dzi tso anyigba (afɔ ƒe ɖiɖi sesẽ, si nana afɔbidɛwo hea alo ƒoa anyigba ne ele zɔzɔm) nye mɔdodo si wotsɔ dia dɔléle kpata si ate ŋu atso acute lumbar disc herniation alo cauda equina compression, anterior tibial compartment syndrome, common peroneal nerve entrapment, gbɔ. tibialis ŋgɔgbe lãkusi ƒe gbagbã, alo ahɔhɔ̃ ƒe titina ƒe ʋuʋu. Ne wò alo ame aɖe si te ɖe ŋuwò kpɔ afɔ ƒe gege kpata si kpe ɖe akɔtave, akɔta ƒe ʋuʋu, alo afɔ si me ʋuʋudedi mele o ŋu la, ƒo ka na wò nutoa me xexlẽdzesi kpata enumake to xexlẽdzesi siwo wozãna kpata. To lãmekawo kple ahɔhɔ̃mekawo ƒe dɔléle kpata siwo do ƒome kplii me le ƒu gbagbãwo kple ƒuwo ƒe ŋeŋe, . cauda equina ƒe dɔléle kple aklã ƒe tete, kple crush injury kple compartment syndrome ƒe dɔléle.

Wɔ esia fifia¶

1. Ðe kpekpeme KAtã ɖa le afɔ si xɔ abi la ŋu enumake eye mègadze agbagba be "yeazɔ adzoe o." Ne èyi edzi tsɔ kpekpeme ɖe Achilles ƒe lãkusi, patellar lãkusi, alo quadriceps lãkusi si gbã keŋkeŋ la hea lãkusi si vuvu la ƒe nuwuwu sentimeta geɖe, egbãa ʋuka si mebɔ o si le paratenon ƒe akɔta, eye ate ŋu atrɔ aɖatsi si ate ŋu anye woda gbe le eŋu le akɔtaɖonu si wɔa dɔ me wòzu amekoko ƒe gbugbɔgatu sesẽ aɖe.
2. Kpɔ enumake hena "Afɔdzideƒe Etɔ̃ Siwo Dzea Afɔ kple Akɔta ƒe Afɔku" (Ƒo ka na 911 / 112 / 999 fifia ne ɖewo li):
3. Cauda Equina alo Acute L4/L5 Radiculopathy Red Flags: Afɔ ƒe gege kpe ɖe akɔta ƒe vevesese sesẽ ŋu, sciatica dada ɖe afɔ ɖeka alo evea dzi, akɔta alo akɔta ƒe ʋuʋu ("saddle anesthesia"), alo kuxi le aɖuɖɔtoe gɔmedzedze alo aɖuɖɔtoe léle me (kpɔ cauda equina ƒe dɔléle si nye cauda equina ƒe dɔléle).
4. Acute Anterior Compartment Syndrome alo Popliteal Artery Occlusion (Knee Dislocation): Afɔ ƒe gege si kpe ɖe eŋu kple vuvu sesẽ, si nu metsina o, si sesẽ abe kpe ene kple vevesese deto le afɔkpodzi ƒe ŋgɔgbe si nu sẽna ɖe edzi ne afɔbidɛwo keke ɖe anyi le mɔ si mewɔa naneke o nu, alo afɔ si le ɣie, si fa miamiamia si me ʋuʋudedi aɖeke mele afɔa tame o (dorsalis pedis) le emegbe klo alo afɔ ƒe abi (kpɔ acute ischemic abɔ kple afɔ).
5. Acute Central Brain Stroke (ACA / Motor Cortex): Afɔ ƒe gege kpata vevesesemanɔmee si kpe ɖe gbɔdzɔgbɔdzɔ le ata ɖeka, akɔta, alɔ, alo mo, nuƒoƒo si me mekɔ o, alo tɔtɔ ŋu.
6. Tsɔ afɔkpodzi alo klo si xɔ abi la ɖo eye nàblae ɖe nɔnɔme si tututu me lãkusiwo naɖe dzi ɖi le esime nèle ɖoɖo wɔm ɖe ʋuɖoɖo ŋu:
7. Ne Wosusu be Achilles Tendon Rupture (Back of Calf/Ankle): Na afɔ si fia asi la ƒe ʋuʋu vie DOWNWARD (le 20 va ɖo 30 degrees of plantarflexion / "tiptoe" nɔnɔme me) to padded splint alo pillows zazã me. MÈgazi Achilles ƒe afɔkpodzi si gbã dzi GBEÐE wòaɖo dzogoe gbadza si ƒe didime nye dzidzenu 90 dzi, elabena afɔa hehe yi dzi la, ema Achilles ƒe nugbɔ siwo vuvu la dome sentimeta 3 va ɖo 5.
8. Ne Wosusu be Patellar alo Quadriceps Tendon Rupture (Klo ƒe Ŋgɔgbe): Na kloa nagaʋuʋu DZƆDZƆDZƆ bliboe (0 degrees of full extension) ɖe ʋuƒo didi aɖe, akɔtaɖonu, alo klo ƒe nutrenu dzi. Mègabɔbɔ kloa gbeɖe o, elabena bɔbɔ hea kloa ƒe nugbɔ kple lãkusi si vuvu la ƒe nuwuwu.
9. Wɔ Thompson Calf-Squeeze Test fafɛ ne wosusu be Achilles ƒe gbagbã. Na amesi xɔ abi la namlɔ aba alo aba dzi ŋkume kple ŋkume eye eƒe afɔ eveawo natsi dziɖeɖi le goa dzi (alo nàdze klo ɖe zikpui dzi eye eƒe afɔwo naɖe ɖa). Mia nyitsu ƒe lãmeka si le afɔ nyuia dzi ƒe titina ƒodo si me lã le la blewuu (afɔa adze anyi le eɖokui si), emegbe nàmimi afɔ si xɔ abi la ƒe nyitsu. Ne afɔa me yi anyime ne womimi nyivi la (Positive Thompson Test) la, Achilles ƒe lãkusia vuvu keŋkeŋ.
10. Ðe asi le fiberglass-fɔkpa sesẽ ɖesiaɖe, ski-fɔkpa sesẽ, alo klo ƒe akɔtaɖonu ɖesiaɖe ŋu alo mãe enumake ne ʋuʋudedi alo afɔ ƒe gege va do mo ɖa. peroneal (fibular) nerve si bɔ xatsa ɖe ƒu ƒe gogloƒe si le afɔa ƒe gota gome le kloa te tututu (fibular neck) la dzi tẽ; nugbɔ si wotsɔ ƒu gbe sesĩe, klonu ƒe ka, alo afɔ ƒe tsotso ɣeyiɣi didi aɖe tea lãmeka sia ɖe ƒua ŋu, si wɔnɛ be ahɔhɔ̃mekawo ƒe dɔwɔwɔ si woate ŋu atrɔ si va nɔa anyi ɖaa ne womeɖe nyaƒoɖeamenu dzi kpɔtɔ le gaƒoƒo aɖewo megbe o.
11. Do afɔa ɖe dzi, nàde tsikpe si wotsɔ avɔ xatsa ɖe eŋu aɖabaƒoƒo 15 va ɖo 20 le ɣeyiɣi ɖeka me (mègatsɔ ƒu ƒe gotagome fibular ta si le kloa te la dzi gbeɖe o), eye nàwɔ ɖoɖo ɖe gbemagbe Kpata Dɔwɔƒe alo ƒumeŋuɖui ƒe dodokpɔ kpata ŋu. Egbegbe Achilles ƒe ɖoɖo siwo womewɔa dɔ na o kple amekoko bia be woatsɔ afɔa ade equinus (plantarflexed) cast alo boot within Gaƒoƒo 24 va ɖo 72 ƒe pop ale be hematoma yeyea xea mɔ na lãkusia ƒe nuwuwu le kadodo me tẽ.

Nyametsotsoti: Vovototodedeameme ƒe vovototodedeameme le nyitsu ƒe pop, klo kekeɖenu ƒe aɖatsi, kple afɔ ƒe ɖiɖi sesẽ¶

flowchart TD
    Start["Acute Lower Extremity Mechanical Pop ALOO Kpata ƒe Mate ŋu Akɔ/Afia Afɔ"] --> DirectionCheck{"Ʋuʋu Kae Bu Alo Vevesese?"}

    DirectionCheck -->|"MATEŊU AFIA AFƆ ÐE ASIME / Atutu Anyigba (‘Pop’ si wose le Nyitsu/Afɔkpodzi ƒe Megbe)"| AchillesBranch["WOBU BE ACHILLES TENDON RUPTURE: 1. Wɔ Thompson Calf-Squeeze Test (Afɔ do kpo afɔkpodzi ƒe ʋuʋu = Positive). 2. Se le ɖokuiwò me be dometsotso si woate ŋu atsɔ asi le si didi sentimeta 2-6 le afɔkpodzi ƒe ƒu tame. 3. Splint afɔkpodzi si fia asi YIME (20-30 deg equinus); ZERO kpekpeme tsɔtsɔ; Kpata/Ƒeŋutinunya ƒe beléle le 24-48h me."]

    DirectionCheck -->|"CANNOT STRAIGHTEN KNEE Against Gravity (Pop in Front of Knee after Jump/Stumble)"| KneeExtensorBranch{"Where is the Palpable Defect & Which Way Did the Kneecap (Patella) Shift?"}

    KneeExtensorBranch -->|"Gap BELOW Kneecap + Kneecap Pulled HIGH Up Thigh (Patella Alta), Age typically < 40"| PatellarTear["PATELLAR TENDON RUPTURE: 1. Immobilize knee 100% STRAIGHT (0 deg extension). 2. Urgent Orthopedic Surgery required within days to reattach tendon to tibial tubercle."]

    KneeExtensorBranch -->|"Gap ABOVE Kneecap + Kneecap Dropped LOW (Patella Baja), Age typically > 40"| QuadTear["QUADRICEPS TENDON RUPTURE: 1. Immobilize knee 100% STRAIGHT (0 deg extension). 2. Urgent Orthopedic Surgical repair required promptly to prevent permanent extensor lag."]

    DirectionCheck -->|"CANNOT LIFT FOOT / TOES UP Toward Shin (Acute Foot Drop / Step-Page Gait)"| FootDropRedFlags{"Kpɔ Neurosurgical & Vascular Emergencies Gbãtɔ: Akɔta/afɔ ƒe vevesese, sɔdola ƒe ʋuʋu, aɖuɖɔtoe ƒe kuxi, ALOO abe kpe sesẽ si le veve sem le afɔkpodzi / afɔ si me ʋu ƒe sisi mele o?"}

    FootDropRedFlags -->|"Ẽ: Akɔtave, Sciatica, alo Tsinyegoe/Saddle Dzesiwo"| SpineEmergency["ACUTE L5 RADICULOPATHY ALOO CAUDA EQUINA SYNDROME: Ƒo ka na 911 / 112 / 999 hena Stat Lumbar Spine MRI & Emergency Neurosurgical Decompression."]

    FootDropRedFlags -->|"Ẽ: Afɔkpodzi Vevesese Sesẽ le Afɔbidɛ si Mewɔa Dɔ O ALOO Afɔ si Me Pulse Le Fafɛ Ŋu"| VascularCompartment["ƲUƲU ƑE ƲUƲU ƑE ƲUƲU ƑE ƲUƲU ALOO POPLITEAL ARTERY OCCLUSION: Ƒo ka na 911 / 112 / 999 hena Fasciotomy / Ʋukawo ƒe Amekoko Kpata."]

    FootDropRedFlags -->|"NO Akɔta alo Ʋukawo ƒe Aflaga Dzĩ: Do Afɔkpodzi ƒe Trɔtrɔ (Tɔtrɔ Afɔkpodzi Yi Eme) ."| InversionTest{"Ðe Dɔnɔa Ate Ŋu Atrɔ Afɔti ƒe Afɔkpodzi YI EMIE (Afɔkpodzi ƒe Trɔtrɔ = Tibialis Posterior, L5)?"}

    InversionTest -->|"Ankle Inversion nye SESE (Megblẽ o), Eversion nye Gbɔdzɔgbɔdzɔ, Numbness le Afɔ Tame/1st Webspace"| PeronealOrTendon["PERONEAL NERVE PALSY (le Fibular Neck) ALOO TIBIALIS ANTERIOR TENDON RUPTURE: Ðe ƒuƒu/ka siwo le klo dzi sesĩe la ɖa; kpɔe ɖa be ka si woate ŋu atsɔ asi aɖo afɔkpodzia ŋgɔ hã; kpata ƒe Ahɔhɔ̃ŋutinunya/Ƒomeŋutinunya ƒe aɖaŋuɖoɖo."]

    InversionTest -->|"Afɔkpodzi ƒe Trɔtrɔ KPLEE Trɔtrɔ KPLE Afɔkpodzi Gblẽna + Akɔta ƒe Abduction Gbɔdzɔgbɔdzɔ"| L5RootOrSciatic["L5 NERVE ROOT LESION, SCIATIC NERVE PALSY, ALOO CENTRAL STROKE: Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ Enumake Ahɔhɔ̃ŋutinunya & MRI Dɔwɔwɔ."]

Nɔnɔme 1: Achilles ƒe Lãmetsiŋusẽ ƒe Gbegblẽ Kpata¶

"Afɔkpodzi alo Tudada le Afɔkpodzi ƒe Megbe" ƒe Nuƒoƒo¶

Achilles lãkusi (calcaneal tendon) nye lãkusi gãtɔ kple sesẽtɔ kekeake le amegbetɔ ƒe ŋutilã me, si wowɔ to gastrocnemius kple soleus nyitsu ƒe lãmekawo ƒe ƒoƒo ƒu kple wo dede afɔkpodzi ƒe ƒu ƒe megbe (calcaneal tuberosity) me. Togbɔ be lãkusia te ŋu nɔa te ɖe agba siwo woate ŋu ahe si ade ŋutilã ƒe kpekpeme ƒe teƒe 8 va ɖo 12 nu le duƒuƒu me hã la, tsidzɔƒe si xɔ ŋkɔ vɔ̃ɖi si me ʋu mekɔna nyuie o le si le sentimeta 2 va ɖo 6 (inch 0.8 va ɖo 2.4) tso eƒe afɔkpodzi si wotsɔ de eme ta.

Ne kamedefefewɔla alo "kwasiɖanuwuwu ƒe aʋawɔla" (zi geɖe la, exɔ ƒe 30 va ɖo ƒe 55 le tenis, pickleball, basketball, bɔlƒoƒo, badminton, alo duƒuƒu me) tsɔ ŋgɔgbefɔ ƒo sesĩe esime kloa le kekem, alo ɖe afɔ ɖe do aɖe me le vome: 1. Seselelãme: Dɔnɔ siwo wu 70 le alafa me trɔna kple dziku be yewoakpɔ amesi ƒo wo ɖe afɔkpodzi ƒe megbe alo tsɔ tenisbɔl alo racket ƒo wo, elabena lãkusi si le ʋuʋum la sena le eɖokui me be esɔ kple ƒoƒo tẽ tso megbe. 2. The Audible Pop: Zi geɖe la, ame siwo le tsitre ɖe adzɔge meta geɖe la sea tu ƒe gbagbã alo gbeɖiɖi sesẽ aɖe. 3. Afɔkpodzi ƒe Bublu Kpata: Amea mate ŋu atutu eƒe afɔbidɛwo ɖa alo awɔ afɔ ɖeka ƒe afɔkpodzi kɔkɔ ɖe akpa si xɔ abi la dzi o, azɔ kple afɔ gbadza si le ƒuƒlu. Zi geɖe la, vevesesea nu fa va zua vevesese si nu mesẽ o le miniti 15 me, si blea amesiwo ŋu wògblẽ nu le dometɔ geɖe be wohea atikewɔwɔ ɖe megbe.

Atike & Afɔku Siwo Gbɔdzɔna le Achilles kple Quadriceps Tendons¶

Kpɔe ɖa ɣesiaɣi be dɔnɔ si va kple lãmeka ƒe gbagbã le eɖokui si alo ŋusẽ sue aɖe ko la do go atikewo alo nɔnɔme siwo gblẽa kolagen Ƒomevi I me hã: - Fluoroquinolone Dɔlékuiwutikewo (Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin): Tsɔ FDA kple EMA Boxed Warning ɖe asi na tendinitis sesẽ kple lãkusi ƒe gbagbã (si gblẽa nu le Achilles lãkusi ŋu le ame 90 le alafa me, eye wògblẽa nu le akpa eve ŋu le dɔléle siwo ade akpa etɔ̃lia me). Fluoroquinolones doa matrix metalloproteinases (collagenase) siwo ɖua lãkusi ƒe lãkusiwo ɖe dzi. Ɣeyiɣi si tsi megbe: Ate ŋu agbã le gaƒoƒo 48 me tso esime wozã dɔlékuiwutike gbãtɔ ALOO vaseɖe ɣleti 6 le dɔlékuiwutike zazã vɔ megbe, eye afɔkua dzina ɖe edzi ŋutɔ le dɔnɔ siwo xɔ wu ƒe 60** alo amesiwo noa corticosteroids le ɣeyiɣi ɖeka me. - Systemic alo Local Corticosteroid Injections: Steroid dodo tẽe ɖe Achilles, patellar, alo quadriceps tendon me alo ƒo xlãe la gbɔdzɔa collagen cross-linking eye wònana wògbãna kabakaba. - Statins, Ayikudɔléle si nɔa anyi didi (Dialysis / Hyperparathyroidism), Gout, Suklidɔ, kple Ƒumeŋuɖui / Lupus.

Dodokpɔ 4 Siwo Wowɔna tsɔ Dea Dzesidede Achilles Tendon Rupture¶

Le Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ la, dɔdaƒe ƒe dɔlélewo didi to American Academy of Orthopedic Surgeons (AAOS) Quartet of Tests zazã me la, le nyateƒe me la, sesẽna wu MRI: 1. Thompson Dodokpɔ (Simmonds-Thompson Calf-Squeeze Test, 96% Sensitivity): Ne dɔnɔa mlɔ anyi ɖe anyi (mo ɖe anyi) le dodokpɔ kplɔ̃a dzi eye eƒe afɔ eveawo le xɔxlɔ̃m le kplɔ̃a ƒe nuwuwu faa la, dodokpɔwɔla la ƒoa nyitsu ƒe titina lãmeka ƒe ƒodo si me lã le la. Zi geɖe la, nyitsua mimi hea Achilles ƒe lãkusia yia dzi eye wònana afɔa ƒe afɔkpodzi nɔa te (fia asi anyi). Le Achilles ƒe gbagbã keŋkeŋ me la, afɔa nɔa anyi kpoo keŋkeŋ ne wotsɔe sɔ kple akpa si le lãmesẽ me. 2. The Matles Test (Knee Flexion Resting Angle Test, 88% Sensitivity): Ne dɔnɔa mlɔ aba dzi ŋkume kple ŋkume la, bia wo be woabɔbɔ klo eveawo ɖe 90-degree angle ale be woƒe afɔkpodziwo nafia dzi tẽe ɖo ta dzisasrãa gbɔ, esime woƒe afɔkpodziwo naɖe dzi ɖi keŋkeŋ. - Afɔ si sɔ: Dzɔdzɔme gbɔɖeme ƒe tete si le Achilles ƒe lãkusi si me gblẽ o me léa afɔa ɖe dzi vie (le \(20\text{ va ɖo }30\text{ degrees}\) ƒe afɔti ƒe ʋuʋu me). - Achilles ƒe Afɔ si gbagbã: Esi nuheŋusẽ hea afɔ si womelé ɖe te o la ɖe anyi Achilles ƒe ka si me gblẽ o manɔmee ta la, afɔ si le axa si gbã la dzea anyi ɖe anyigba gbadzaa (neutral \(0\text{ degrees}\)) alo dorsiflexed position (Positive Matles Sign). 3. Palpation of a Tendon Gap (Defect): Ne ètsɔ asibidɛ eve ƒu du blewuu to Achilles ka la dzi sentimeta 2 va ɖo 6 le afɔkpodzi ƒe ƒu tame la, àkpɔ divot alo dometsotso si me do le si to vovo afisi lãkusia vuvu le (woase le wo ɖokui me nyuie wu le gaƒoƒo 24 gbãtɔwo me hafi ʋumenugbagbeviɣia ƒe vuvu nayɔ dometsotsoa me). 4. Ðiɖeɖi le Gbɔɖeme Afɔkpodzi Afɔkpodzi Tone & Ŋutete Mawɔmawɔ Afɔ Ðeka Afɔkpodzi Kɔkɔ.

Nusitae Equinus (Plantarflexion) Splinting Enumake le Gaƒoƒo 48 Gbãtɔwo Me Trɔa Nusianu¶

Dɔdamɔnu dodokpɔ ɖedzesi siwo wowɔ le vome (abe SMART kple UKSTAR dodokpɔwo ene) trɔ asi le Achilles ƒe gbagbã dzi kpɔkpɔ ŋu: dɔwɔwɔ si mewɔa dɔ o ƒe gbugbɔgaɖɔɖo le wedge-fɔkpa tɔxɛ aɖe me ɖoa gbugbɔgagbã ƒe agbɔsɔsɔ si bɔbɔ nenema ke (2 va ɖo 4 le alafa me) abe amekoko si wowɔ le gaglãgbe ene, NE BE afɔa meʋãna le equinus blibo me o (plantarflexion, \(20\text{ to }30\text{ degrees}\) toes-down) enumake le gaƒoƒo 24 va ɖo 72 gbãtɔwo me. - Ne wofia afɔa ɖe anyime le equinus me le abixɔxɔa megbe teti la, Achilles ƒe lãkusi ƒe nugbɔ eve siwo vuvu la ka wo nɔewo le paratenon ƒe abɔta si me gblẽ o la me, si wɔnɛ be ʋu yeye si me ʋu sina tona (si me ʋumenugbagbevi dzĩwo kple fibroblasts sɔ gbɔ ɖo) te ŋu gaƒoa lãkusia ɖe wo nɔewo ŋu le eƒe gbɔɖeme ƒe didime si sɔ nu. - Ne dɔnɔ aɖe zɔ afɔkpa gbadzaa me alo wotsɔe da ɖe afɔkpa gbadza si ƒe didime nye dzidzenu 90 me kwasiɖa ɖeka hafi yi eŋutinunyala bibi aɖe gbɔ la, Achilles la hayana edidi (si keke sentimeta 2 va ɖo 3), si wɔnɛ be amea ƒe nyivi ƒe gbɔdzɔgbɔdzɔ tegbee eye wòtsia anyi le eƒe agbemeŋkekewo katã me si hiã be woawɔ dɔ sesẽ aɖe na amea. - High-DVT Afɔku Nuxlɔ̃ame: Esi wònye be afɔ ƒe anyime ƒe ʋuʋu le equinus cast alo boot me le Achilles ƒe gbagbã megbe na nyitsu ƒe lãmeka ƒe pɔmpia tɔ te ta la, Achilles ƒe lãkusi ƒe gbagbã tsɔa agbɔsɔsɔ gãtɔ kekeake dometɔ ɖeka deep vein thrombosis (DVT) kple aklã me ʋu ƒe sisi le ƒuŋutinunya me (si ade 5 va ɖo 30 le alafa me le ultrasound me); atikewɔlawo daa atikewo ƒe DVT ƒe mɔxexeɖedɔléle nu kpɔna edziedzi (abe heparin si ƒe molecule ƒe kpekpeme mede o alo ʋumenugbagbeviɣitike siwo woano tẽ ene) le ʋumenugbagbeviɣidɔa me.

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Nɔnɔme 2: Patellar Tendon Tear kple Quadriceps Tendon Rupture (Klo Kekeɖenudɔwɔwɔ) .¶

klo ƒe kekeɖenudɔwɔwɔ nye kɔsɔkɔsɔ si yia edzi si me aklo ene ƒe lãmeka -> akɔta ƒe lãkusi -> akɔta ƒe lãkusi (klo ƒe lãkusi) -> afɔkpodzi ƒe lãkusi (ligament) -> tibial tubercle si le afɔkpodzi ƒe tame. Ne kɔsɔkɔsɔ sia ƒe ka aɖe vuvu keŋkeŋ la, amea mate ŋu aɖɔ eƒe klo ɖo vevie ɖe nuheŋusẽ ŋu o eye woƒe klowo blana enumake ɣesiaɣi si wòdze agbagba be yeatsi tre ɖe edzi.

Differentiating Quadriceps Tendon vs. Patellar Tendon Rupture¶

(Clinical Pitfall: Just as accessory muscles can fool clinicians in an Achilles rupture, an intact medial and lateral patellar retinaculum on the sides of the knee may allow a patient with a central tendon tear to weakly hold their leg straight once a doctor lifts it for them, even though they have a 20-to-30-degree extensor lag when trying to lift it themselves. Always test active knee extension from a 45-degree bent position against gravity).

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Condition 3: Acute Foot Drop Triage (Spine vs. Nerve vs. Compartment vs. Tendon)¶

Afɔ ƒe ɖiɖi nye ŋutetemanɔamesi be woakɔ afɔ ƒe ŋgɔgbe kple afɔbidɛwo ɖe dzi aɖo ta afɔkpodzi gbɔ (afɔkpodzi ƒe megbeʋuʋu ƒe bu). Esi wònye be afɔbidɛawo nɔa anyime le azɔlizɔzɔ ƒe ʋuʋu ƒe akpaa me ta la, ele be dɔnɔa nahe woƒe afɔbidɛwo ato anyigba alo akɔ woƒe klo ɖe dzi le mɔ si mesɔ o nu abe atrakpui lialia ene ("afɔɖeɖe ƒe azɔlizɔzɔ") eye wòaƒo eƒe afɔ ɖe anyi sesĩe le afɔɖeɖe ɖesiaɖe me.

Afɔ ƒe ɖiɖi kpata nye dɔléle didi ƒe aɖaŋu si me afɔku le ŋutɔ elabena nudzɔdzɔ kpata atɔ̃ siwo to vovo kura le ahɔhɔ̃, akɔta, afɔ ƒe ʋukawo, lãmeka siwo le gota, kple afɔkpodzi ƒe lãkusiwo me ate ŋu ahe esia vɛ. Zã dɔdamɔnu ƒe kplɔ̃ sia si wotsɔ sɔ kple wo nɔewo kple abadzivɔ ƒe ŋutilãmedɔdada nàtsɔ ade dzesi nusi tututu gbɔ wòtso:

Aɖaŋudzedze ƒe dɔdamɔnu tsɔtsɔ sɔ kple nu 5 siwo hea afɔ ƒe ɖiɖi kpata vɛ¶

Sekɛnd 10 ƒe Abati ƒe Safui: Afɔkpodzi ƒe Trɔtrɔ Dodokpɔ Be Woaɖe Akɔta Kple Klo ƒe Lãmetsiŋusẽ Aɖe¶

Ne dɔnɔ aɖe va ɖo kple afɔdzidede sesẽ la, aleke atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ awɔ anya enumake nenye be kuxia nye ahɔhɔ̃mekawo ƒe dɔwɔwɔ kpata le akɔta ƒe akpa si le anyime (L5 lãmeka ƒe ke) tsɔ wu benign peripheral nerve pinch le gota klo (common peroneal nerve)? - Wodoa ANKLE INVERSION (wobia tso dɔnɔa si be wòatrɔ woƒe afɔ si xɔ abi la ƒe afɔkpodzi YI ME aɖo ta afɔ kemɛa gbɔ ɖe dodokpɔwɔla ƒe asi ŋu) kple HIP ABDUCTION (si wotu ata ɖe gota): 1. Tibialis Anterior (si kɔa afɔ ɖe dzi) kple Tibialis Posterior (si trɔa afɔ ƒe afɔkpodzi yia eme) siaa xɔa woƒe lãmekawo tso L5 aklã ƒe lãmeka ƒe ke si le akɔta ƒe akpa si le ete. 2. Gake le ata ƒe kɔkɔme la, L5 lãmeka mawo ma ɖe mɔ gã vovovo eve me: ka siwo kɔa afɔa ɖe dzi la zɔa mɔ yia Common Peroneal Nerve (si xatsa ɖe gotagome ka ƒe kɔ ŋu le klo gbɔ), gake ka siwo trɔa afɔa yia eme (trɔtrɔ) ya zɔna toa Tibial Nerve si wokpɔ ta na la me le nyitsua ƒe megbe goglo. 3. Dɔdaƒe ƒe Se: - Ne dɔnɔa ƒe Afɔ ƒe Dzedze + Afɔkpodzi ƒe Trɔtrɔ GBLẼ (mate ŋu atrɔ afɔkpodzi yi eme o) + Akɔta ƒe Ʋuʋu GBƆGBƆ la, abi la le KƆKƆE le L5 L5 Nerve Root le Lumbar Spine (alo Sciatic Nerve) -> Ehiã be woawɔ akɔta ƒe MRI kpata. - Ne dɔnɔa ƒe Afɔ ƒe Dzedze + Afɔkpodzi ƒe Trɔtrɔ Sesẽ (trɔna afɔkpodzi yi eme sesĩe) + Afɔkpodzi ƒe Trɔtrɔ si gbɔdzɔ le eŋu la, abi la nye LOW DOWN le Common Peroneal Nerve le Fibular Neck -> Kpɔe ɖa enumake be wotsɔe ƒu gbe sesĩe, klo ƒe akɔtaɖonu, fibular head fracture, Baker’s cyst, alo afɔ ƒe tsotso si nye numame nɛ hã.

Ale Si Nàwɔ De dzesi Tibialis Anterior Tendon Rupture (Mɔ̃ɖaŋununya ƒe Afɔdzideƒe Srɔ̃la) .¶

Le ame tsitsi siwo xɔ tso ƒe 50 va ɖo ƒe 75 gome (alo ne wotso afɔkpodzia ƒe ŋgɔgbe ɖaɖɛ tso ahuhɔ̃e alo ski-fɔkpa ƒe nugbɔ vɔ megbe) la, tibialis anterior tendon ate ŋu agbã le afisi tututu wòtso afɔkpodzi ƒe ƒunukpeƒe ƒe ŋgɔgbe le: - Kpɔ Afɔkpodzi ƒe Ŋgɔgbe Ne èle Afɔbidɛwo Kɔkɔm: Zi geɖe la, ne èhe wò afɔ kple afɔbidɛwo yi dzi ɖo ta wò ŋɔti gbɔ be woagatsi tre ɖe eŋu o la, lãkusi ƒe ka si le ɣie si lolo abe pɛnsil ene (tibialis anterior tendon) dona ɖe wò afɔkpodzi ƒe ŋgɔgbekpa ememetɔ dzi. - Le Tibialis Anterior Tendon Rupture me la, ka ememetɔ ma si ɖe dzesi la bu, wotsɔ lãkusi falɛfalɛ si lolo abe walnut ene ("pseudotumor") si ƒe lãkusi si wogbugbɔ ɖe megbe si kɔkɔ sentimeta 3 va ɖo 5 le afɔkpodzia dzi, esime extensor hallucis longus (EHL) lãkusi (si kɔa afɔbidɛ gã la) wɔa dɔ ɣeyiɣi didi aɖe le dzodzro be woahe afɔ bliboa ayi dzi (clawing/hyperextension of the big toe). Ŋutilã ƒe seselelãme sɔ 100 le alafa me.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

• United States kple Canada: Ƒo 911 na afɔ ƒe gege sesẽ kple aklã ƒe aflaga dzĩwo (cauda equina), ʋusɔgbɔdɔ ƒe dzesiwo, alo ʋukawo/xɔme dɔléle ƒe dzesiwo. Wɔ ɖe American Academy of Orthopedic Surgeons (AAOS) Dɔdamɔnu ƒe Mɔfiamewo dzi na Acute Achilles Tendon Rupture (equinus ƒe ʋuʋu kabakaba le gaƒoƒo 48 me kple DVT ƒe afɔku ƒe hatsotsowo me toto).
• United Kingdom: Ƒo 999 (alo 112) na cauda equina, ʋusɔgbɔdɔ, alo abɔ kple afɔ ƒe ʋusɔgbɔdɔ. Ne Achilles ƒe lãkusi ƒe gbagbã siwo ɖe wo ɖokui ɖe aga la, yi A&E alo NHS Minor Injuries Unit / Virtual Fracture Clinic gbemagbe ke ale be woatsɔ afɔkpodzia ade equinus boot/plaster cast me eye woadae akpɔ be venous thromboembolism (VTE) ƒe mɔxexeɖedɔléle nu le NICE Guideline NG89 kple BOAST (British Orthopedic Association) te Dzidzenuwo na Trauma) ƒe ɖoɖowo.
• Europa Dukɔwo ƒe Habɔbɔ: Ƒo 112. Wɔ ɖe ESSKA (European Society of Sports Traumatology, Knee Surgery & Arthroscopy) ƒe mɔfiame siwo dzi woda asi ɖo le Achilles sesẽ kple klo ƒe kekeɖenudɔwɔwɔ ƒe abixɔxɔ ŋu dzi.
• Australia kple New Zealand: Ƒo 000 le Australia alo 111 le New Zealand. Wɔ ɖe Australia Ƒumeŋutinunyalawo ƒe Habɔbɔ (AOA) kple ANZCOR ƒe mɔfiamewo dzi hena lãmekawo ƒe ʋuʋu kple ahɔhɔ̃mekawo ƒe dɔwɔwɔ.
• India kple Asia-Pacific: Ƒo 112 le India, 119 le Japan kple South Korea, alo 995 le Singapore. Le nuto siwo me nugododeƒe si le ʋuʋu ɖi (si gena ɖe anyikpe me) lãa Achilles ƒe lãkusi enuenu abe ʋuʋudedi si le ʋuʋu ɖi ene la, tsɔa dɔlékuiwutike ƒe nyaƒoɖeamenu tẽ ɖu ʋu si le dodom dzi, na afɔkpodzia nabɔbɔ, eye woatsɔe enumake hena amekokoxɔ me ɖeɖeɖa, tetanus mɔxexeɖedɔléle nu, dɔlékuiwutike siwo wozãna le ʋuka me, kple lãkusia dzadzraɖo gbãtɔ.

Kpɔ ɖa xexlẽdzesi siwo wozãna kpata na dukɔwo dome dɔdɔ ƒe xexlẽdzesiwo katã.

Nya siwo wobiaa amewo enuenu¶

Aleke nye Achilles lãkusi ate ŋu agbã keŋkeŋ ne megate ŋu fiaa asi nye afɔ eye meʋuʋua nye afɔbidɛwo le aba dzi?¶

Achilles ƒe lãkusi (gastrocnemius kple soleus lãmekawo) naa ŋusẽ wò abe 80 le alafa me ene be wòatutu wò ŋutilã ƒe kpekpeme ayi dzi va ɖo wò afɔbidɛwo dzi, gake lãmeka evelia sue etɔ̃ siwo le wò nyivi ƒe gogloƒe (**flexor hallucis longus, flexor digitorum longus, kple tibialis posterior**) toa wò afɔkpodzi ƒe ƒu ememetɔ megbe ɖe vovo tso Achilles gbɔ. Lãmetsi sue etɔ̃ mawo gakpɔtɔ ɖea mɔ na wò be nàʋuʋu wò afɔbidɛwo eye nàfia asi wò afɔ ɖe yame gbɔdzɔgbɔdzɔtɔe esime nèmlɔ anyi, si tae ɖɔktawo ɖoa ŋu ɖe **Thompson nyitsu ƒe nutete dodokpɔ** kple afɔ ɖeka ƒe afɔkpodzi kɔkɔ ŋu tsɔ wu afɔ si le dɔ wɔm si fia asi yame ɖo.

Ðe wòle be woawɔ dɔ nam le Achilles ƒe lãkusi si vuvu keŋkeŋ ta, alo ɖe wòate ŋu ada le afɔkpa mea?¶

Egbegbe dɔdamɔnu dodokpɔ siwo wowɔ le vome (abe UKSTAR kple SMART dodokpɔwo ene) ɖo kpe edzi be ne wotsɔ Achilles ƒe lãkusi si ŋe la de **equinus (afɔbidɛwo-fiã ɖe anyi) cast alo wedge boot tɔxɛ aɖe me le gaƒoƒo 24 va ɖo 72 gbãtɔ** me le abixɔxɔ vɔ megbe eye wotsɔ dɔwɔwɔ ƒe gbugbɔgaɖɔɖo ƒe ɖoɖo si woɖo ɖe ɖoɖo nu si tsɔa kpekpeme kaba kplɔnɛ ɖo la, lãkusia daa gbe le **ewɔa dɔ nyuie nenema ke re-rupture rate (2 va ɖo 4 le alafa me) abe amekoko** ene esime wole asa ƒom na amekoko ƒe abi ƒe dɔlékuiwo kple lãmekawo ƒe abi. Zi geɖe la, wowɔa amekoko na nuƒoƒo siwo tsi megbe (afisi dometsotso aɖe ʋu xoxo), kamedefefewɔla bibi siwo tia bɔmb, alo afɔkpodzi ƒe ƒu ƒe ʋuʋu.

Nukatae ɖɔkta si kpɔa dɔnɔwo dzi kpata la tsɔ ka bla nye afɔkpodzi wòfia anyime abe ballerina ene le esi teƒe be wòanɔ gbadzaa le dzidzenu 90 me?¶

Ne wò Achilles lãkusia vuvu la, wò nyivi ƒe lãmeka hea lãkusia ƒe nuwuwu si le etame yia dzi esime nuheŋusẽ hea wò afɔ yia anyime. Ne ame aɖe mã wò afɔkpodzi gbadzaa le dzogoe si nye dzidzenu 90 dzi la, wohea Achilles ƒe lãkusi ƒe nugbɔ eve siwo vuvu la dome didi sentimeta 3 va ɖo 5 eye womate ŋu aka asi wo nɔewo ŋu be woahaya o. Ne èfia afɔa yi anyime le dzidzenu 20 va ɖo 30 (**plantarflexion / equinus**) hea afɔkpodzi ƒe nugbɔ si le ete la trɔna yia dzi tututu be wòagbugbɔ nu na nyitsu ƒe nugbɔ si le etame ale be ŋutilãa nate ŋu aƒo wo nu ƒu le tete si sɔ me.

Nukatae ciprofloxacin alo levofloxacin nono na aɖuɖɔtoe alo aɖuɖɔtoedɔléle ate ŋu ana nye Achilles lãkusi nagbã le ɣleti aɖewo megbe?¶

Fluoroquinolone dɔlékuiwutikewo (ciprofloxacin, levofloxacin, moxifloxacin) gena ɖe lãkusi ƒe lãkusi me eye wowɔa **matrix metalloproteinase (MMP) enzymes** ŋudɔ esime wole fibroblast collagen wɔwɔ nu tsim, si nana Achilles lãkusi ƒe wɔwɔme collagen ka siwo le nusuekpɔmɔ̃ me gbɔdzɔna. Esi wònye be tendon collagen trɔna blewu ŋutɔ ta la, xɔtuɖoɖo ƒe gbɔdzɔgbɔdzɔ ma nɔa anyi **vaseɖe ɣleti 6 le wò dɔlékuiwutike mamlɛtɔ mimi vɔ megbe**; ne afɔkpodzi alo nyitsu ƒe veve aɖe va le ŋuwò esime nèle fluoroquinolone nom alo le ewuwu vɔ megbe la, dzudzɔ kamedede enumake eye nàte ɖe wò ɖɔkta ŋu.

Ne mefɔ kple "afɔ kuku" (afɔ ƒe ɖiɖi) le alɔ̃dɔdɔ kple nye afɔ si wotso alo klonu si wotsɔ blaa klonu sesẽ vɔ megbe la, ɖe wòagatrɔ ava?¶

Ne afɔ ƒe gege tso **peroneal nerve si bɔ** ƒe gotagome tete ɖe gota fibular neck bone si le kloa te tututu (tso afɔ ƒe tsotso, ƒoƒo sesĩe, alo gota klo ƒe akɔta ɖe nugbɔ sesẽ aɖe dzi) gbɔ la, zi geɖe la, lãmekaa kpea fu le eƒe myelin sheath (**neurapraxia**) ƒe ʋuʋu ƒe mɔxexe hena ɣeyiɣi aɖe tsɔ wu be wòatso lãmeka ƒe ka siwo wotso. Ne èɖe nyaƒoɖeamenua ɖa enumake, mègatso wò afɔwo o, eye nèzã **Ankle-Foot Orthosis (AFO) brace** be wòaxe mɔ ɖe afɔkpodzi kple Achilles ƒe sesẽ nu la, compressive peroneal palsies siwo wu 80 va ɖo 90 le alafa me hayana keŋkeŋ le **kwasiɖa 2 va ɖo 12** me.

Nukatae patellar tendon kple quadriceps tendon ƒe aɖatsiwo hiãna ɣesiaɣi kloe be woawɔ dɔ na wo evɔ zi geɖe la, Achilles ƒe aɖatsiwo ya mehiãna o?¶

Le Achilles ƒe gbagbã me la, ne èfia afɔa ɖe anyime le afɔkpa me la, etua lãkusi eveawo ƒe nugbɔ siwo vuvu la ɖe wo nɔewo ŋu le mɔ si mewɔa naneke o nu eye wòkpɔa wo ta tso nuheŋusẽ me. Le **patellar tendon alo quadriceps tendon tear** blibo si le kloa ƒe ŋgɔgbe me la, quadriceps lãmeka sesẽ si le ata me hea klo ƒe ta alo etame tendon stump ɣesiaɣi sentimeta geɖe tso afisi aɖatsi le, eye klo sue ɖesiaɖe si wobɔbɔ la hea wo dome yi ŋgɔe; ne womewɔ amekoko kpata ƒe aŋe to ƒumeŋuɖuiwo me le ŋkeke ʋɛ aɖewo me tso esime woxɔ abi o la, abi ƒe lãkusi si gbɔdzɔ la yɔa dometsotsoa me eye amea megate ŋu ɖɔa klo ɖo tegbee o.

Mɔfiame siwo do ƒome kplii¶

• Ƒu gbagbã, ƒu gbagbã, kple ƒuwo ƒe ŋeŋe
• Abɔta, klo, kple ƒunukpeƒewo ƒe ʋuʋu
• Cauda equina syndrome and acute spinal cord compression red flags
• Crush injury kple compartment syndrome ƒe dɔléle

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• American Academy of Orthopaedic Surgeons (AAOS, United States): Clinical Practice Guideline on the Diagnosis and Treatment of Acute Achilles Tendon Rupture (Thompson test, Matles test, early functional equinus rehabilitation vs. surgical repair, and VTE assessment).
• National Institute for Health and Care Excellence (NICE, United Kingdom) and British Orthopaedic Association (BOAST): Venous Thromboembolism in Over 16s: Reducing the Risk of Hospital-Acquired Deep Vein Thrombosis or Pulmonary Embolism in Lower Limb Immobilisation (NG89) and UKSTAR Trial Functional Bracing Protocols.
• European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA): Consensus Statements on the Management of Acute Achilles Tendon Ruptures and Knee Extensor Mechanism (Quadriceps and Patellar Tendon) Injuries.
• United States Food and Drug Administration (FDA) and European Medicines Agency (EMA): Drug Safety Communications and Boxed Warnings on Fluoroquinolone-Associated Tendinopathy and Tendon Rupture.
• American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM): Practice Parameter for Electrodiagnostic Evaluation of Acute Foot Drop (Common Peroneal Neuropathy vs. L5 Radiculopathy).