Diagnosis of Achilles Tendon Pathology: Ultrasonography Versus Plain X-ray
Moshiur Rahman Khasru *
Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Farzana Nazrin
Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Md Abu Bakar Siddiq
Physical Medicine Centre, Chittagong, Bangladesh.
Tangila Marzen
Dhaka Medical College and Hospital, Bangladesh.
Nayeem Anwar
Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Fariha Haseen
Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Mohammad Moniruzzaman
Department of Physical Medicine and Rehabilitation, Dhaka Medical College, Bangladesh.
Israt Jahan
Department of Biochemistry, University of Science and Technology Chittagong, Bangladesh.
Mohammad Ahsan Ullah
Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Syed Mizanur Rahman
Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Abul Khair Mohammad Salek
Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Aims: The current study aimed to highlight diagnostic usefulness of ultrasonography (USG) in Achilles tendon pathology.
Methods: This cross-sectional study was conducted in the department of Physical Medicine and Rehabilitation in co-operation with Orthopedics and Traumatology facility of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study period was 2 years (July 2010 to June 2012); and 61 patients with posterior heel pain selected consecutively. Along with history taking, enrolled subjects examined meticulously. Non-invasive measures such as X-ray, USG (Siemens premium edition, Acuson antares, transducer: VF 10-5, 5.7-10 MHz) also used to acquire further information regarding heel pathology. A semi-structured questionnaire used to preserve primary data. Since, four subjects refused to do USG and X-rays were not available from another seven, we studied over rest fifty. Uni-variate analysis performed. Having been used kappa statistics, sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound and X-ray in several Achilles tendon pathologies performed; p < 0.05 considered statistically significant.
Results: Among of all participants, 38.0% belonged to 36-45 age range and maximum (68.0%) were male. Although a substantial 37 (76.0%) had been suffering from localized back heel pain, 13 (26.0%) of them had systemic diseases like diabetes mellitus (76.9%), dyslipidaemia (1, 2.0%), systemic lupus erythematosus (1, 2.0%), and ankylosing spondylitis (1, 2.0%). Achilles tendinitis, Achilles tendon rupture, retrocalcaneal bursitis, tendon xanthoma diagnosed using ultrasonogram in 31 (62.0%), 7 (14%), 3(6%), and 1 (2.0%) patients respectively. Concerning Achilles tendon pathology, USG was 95.0% sensitive, 50.0%, specific, and 92.0% accurate, whereas diagnostic sensitivity, specificity, and accuracy for X-ray was 39.0%, 75.0%, and 42.0% respectively.
Conclusion: In diagnosing soft tissue pathologies in and around Achilles tendon ultrasound is far better option than conventional X-ray.
Keywords: Achilles tendon pathology, diagnosis, ultrasound, X-ray