Copeland Test | Achilles Tendon Rupture/Tear Assessment

66% of Achilles tendon ruptures are asymptomatic ruptures. This means that these patients never had Achilles tenderness, stiffness, pain, or dysfunction. However, there has to be some kind of pathology present in the tendon as 98% of ruptured tendons have degenerative pathology, while 2% have other pathology. If you want to know more tendon facts, check the link in the description for our blog on the 7 tendon truths you should know.

Reiman et al. (2014) conducted a systematic review with meta-analysis of studies examining the diagnostic accuracy of various clinical assessments to diagnose a rupture of the Achilles tendon without the need for an MRI. Among other tests, such as the calf squeeze test we already discussed here on Physiotutors, the Copeland test is described in the literature. According to the article by Reiman et al. (2014), this test has a sensitivity of 78%, and this is the only statistical value that could be extracted from the source article of Maffulli et al. The study had a high risk of bias too, which is why the tests’ clinical value should be regarded as rather weak.

The test requires the use of a sphygmomanometer or blood pressure cuff. The patient is in prone lying position with the affected leg placed over the edge of the treatment bench.

The sphygmomanometer cuff is placed around the middle of the calf and inflated to 100mmHg while the ankle is in passive plantar flexion. Then the patient’s ankle is dorsiflexed. In case the tendon is intact, you should experience a pressure rise of between 35 to 60mmHg. If the tendon is ruptured, there will be little to no rise in pressure.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other common tests for Achilles tendon ruptures:

• Thompson Test
• Gap Palpation Test
• Matles Test

References

Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. The American journal of sports medicine. 1998 Mar;26(2):266-70.

Reiman M, Burgi C, Strube E, Prue K, Ray K, Elliott A, Goode A. The utility of clinical measures for the diagnosis of achilles tendon injuries: a systematic review with meta-analysis. Journal of athletic training. 2014;49(6):820-9.