ROLE OF HIGH RESOLUTION ULTRASOUND IN THE DISORDERS OF ACHILLES TENDON.

Background: The Achilles tendon is the most common tendon that can get injured. The tendon can get affected in a wide variety of conditions and present with varied clinical manifestations. A detailed knowledge of the conditions affecting this tendon, their clinical manifestations and their appearance in imaging studies will help narrow down the diagnosis and provide precise treatment. Aim: Aim of the study was to identify the most common pathologies that affect the Achilles tendon and to correlate the clinical presentation with the high resolution ultrasound appearance. Settings and design: This was a prospective study Methods and Material: 52 patients with suspected Achilles tendon pathology were evaluated. After taking a detailed clinical history and performing a clinical examination, HRUS was performed on all the patients. The disorders affecting the patients were characterised based on clinical presentation and ultrasound examination. Correlation was done between the clinical and HRUS presentation of these cases. Results The most common symptom at the time of presentation was pain which was present in 41 patients (78.9%). Other symptoms included loss of plantar flexion seen in 20 patients (38.4%), swelling in 36 patients (69%) and stiffness seen in 12 patients (23%). Tears in the tendon were the most common type of pathology noted in 25 patients (48.07%),18 patients (34.6%) presented with complete tears and 5 patients (13.4%) with partial tears. Complete tears occurred more frequently at a site 3-4 cm from the calcaneal insertion while partial tears were most commonly insertional. 10 (19.2%) patients had findings suggestive of tendinopathy and their most common complaint was chronic pain and swelling. 5 patients (9.62%) had features of enthesitis. Among them 3 had psoriatric arthropathy and 2 had ankylosing spondylitis. Conclusion The spectrum of disorders involving the Achilles tendon are diverse and the clinical examination maybe imprecise, especially in acute conditions. HRUS offers a highly accurate tool that can diagnose these conditions and guide the management. Keywords: Tendoachilles, Achilles tendon, Paratendinopathy, Tendinopathy, Tears, High resolution ultrasound