Clinical tests for Achilles tendon rupture, compared

A tear through the Achilles tendon, usually complete, typically during a sudden push-off. Often felt as a sudden pop, or as if kicked in the back of the heel.

The 3 tests in the library for Achilles tendon rupture, side by side, each with the published accuracy figures that exist for it. Click a test for what each result means, any caution, and the source.

Test	Sensitivity	Specificity	LR+	LR−	Verdict
Matles test	88%	85%	5.87	0.14	Useful in both directions
Palpable Achilles tendon gap/defect	73%	89%	6.64	0.3	Best used to rule in
Thompson (Simmonds) test	96%	93%	13.71	0.04	Useful in both directions

Reading the table

A high LR+ makes a positive result useful for ruling the condition in; a low LR− makes a negative result useful for ruling it out. A test can be good in one direction and weak in the other, and the figures come from different studies and patient groups, so compare them with care.

All three figures come from one study at high risk of bias, and no combination of these signs has been tested.

Tests for the same problem are rarely independent, so a second positive adds much less than its own figure suggests. Do not multiply their figures together. Where a combination has been tested as a cluster or a decision rule, Rule It In, Rule It Out gives that published result.

To turn a figure into a probability for your patient, use the probability calculator.

Get the book for spotting a high ankle sprain, and knowing when the Achilles is torn

This page gives the published figures. Rule It In, Rule It Out adds how to do each test, what counts as positive, how to read the result, and, where studied, whether combining tests helps.

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One study, one test, once a month

Rule It In is a free evidence letter for musculoskeletal clinicians: one recent study explained, one examination test with its real numbers. From Trokos, publisher of Rule It In, Rule It Out.

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