Although fairly uncommon, a tendon rupture can be a serious problem and may result in excruciating pain and permanent disability if untreated. A group of four muscles -- the vastus lateralis, vastus medialis, vastus intermedius, and the rectus femoris -- come together just above the kneecap (patella) to form the patellar tendon.
Often called the quads, this group of muscles is used to extend the leg at the knee and aids in walking, running, and jumping. This tendon is vital for pushing off with the foot (this motion is known as plantarflexion).
The rotator cuff is located in the shoulder and is actually composed of four muscles: the supraspinatus (the most common tendon ruptured), infraspinatus, teres minor, and subscapularis. This group of muscles functions to raise your arm out to the side, helps you rotate the arm, and keeps your shoulder from popping out of its socket.
The rotator cuff tendon is one of the most common areas in the body affected by tendon injury. You may notice a crunchy sound or feeling when you use the tendon.The symptoms of a tendon injury can be a lot like those caused by bursitis. Read What Your Physician is Reading on Medscape Patellar Tendon Rupture »The patellar tendon ruptures relatively infrequently.
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This 44-year-old female patient, previously a professional water skier, presents with 80% low back pain and 20% leg pain demonstrating a L5 distribution. Although a L5 selective nerve root block provided short-term relief, there was no response to facet injections. Please login or register, to gain full access to this case and participate in the discussion. Chondromalacia patellae is chronic softening and degeneration of the cartilage on the underside of the kneecap (patella).
Symptoms of chondromalacia patellae include tenderness of the knee, grinding or grating feeling when flexing the knee, knee pain that gets worse when climbing stairs or getting out of a chair, and knee pain in the front of the knee that occurs when getting up after sitting for a long time. Immediate treatment steps include resting the knee and taking nonsteroidal anti-inflammatory drugs to relieve inflammation and pain. If the pain does not improve and signs of arthritis develop around the kneecap, arthroscopic surgery may be an option to remove the damaged kneecap cartilage.
The material provided on this web site is for educational purposes only, and is not under any circumstances to be used for medical advice, diagnosis or treatment. Knee diagramKnee pain is a very common complaint that can be caused by a wide variety of factors.
Overuse is also a common cause of knee pain, and can include muscle strains, tendonitis, and bursitis.
Acute knee injuries, such as torn ligaments and torn cartilage, frequently occur during sports activities that involve turning, running, jumping, and sudden stops, or contact sports such as football and wrestling. Surgical Treatment Varicocele Embolization Frequently Asked Questions Which Treatment which Patient Varicose Vein Treatment Varicocele Treatment Varicocele Embolization Varicocele embolization was first performed in 1979 and since then, it has become more and more popular. Each type of tendon rupture has its own signs and symptoms and can be treated either surgically or medically depending on the severity of the rupture and the confidence of the surgeon. It is the site of attachment of the calf muscle (gastrocnemius muscle) to the heel of the foot (the calcaneus bone). Overuse is a known risk factor for rotator cuff tears, but this case suggests that it can also be a risk factor for quadriceps tendon rupture. Her symptoms have been severe for more than two years, but low back pain has been modest for more than 5 years.
The patient then underwent a minimally invasive posterior decompression and pedicle screw instrumentation and fusion at L4-L5 and L5-S1. Females are more likely to experience this knee pain problem because they have a greater Q angle, which is the angle between the quadriceps and the patella tendon. A doctor or physical therapist can show you exercises to strengthen your quadriceps and stretch your hamstrings, which will help hold the kneecap in the correct position.
Most of the causes of knee pain are associated with an injury or mechanical problem that involves one or more of the structures that allow the knee joint to function and for athletes and others to perform often complex movements. In the beginning, the knee pain is often mild and intermittent, but if you continue the overuse-cycling, kneeling, heavy lifting or climbing-where small stresses are repeated many times without allowing enough time for recovery in between, then the pain worsens over time.

The anterior cruciate ligament (ACL) is one of four major knee ligaments and also one that is often the target of injury. Lamperti narrates an intraoperative video that shows how balloon sinuplasty can be used to dilate the forehead or frontal sinus to treat chronic sinusitis. Generally hydrocele will fade away within a few months of birth but sometimes it can occur with inguinal hernia.
The most distinct advantage of embolization is that during the procedure, a venography is done and the refluxing veins can be easily seen and differentiated from the normal veins. Chondromalacia patellae also occurs more often in individuals who have a history of knee fractures, knee dislocations, and other knee trauma. Wearing special shoe inserts or orthotics can help people who have flat feet or who pronate, and a knee support can help prevent symptoms.
When one or more of the structures involved in the knee joint does not operate well or work together smoothly with the others, the result is an imbalance in the knee joint causing pain, reduce movement and function, and muscle weakness.
When the muscles and tendons become overly stressed, microscopic tears develop, and inflammation often sets in.
Because the ACL is critical to knee stability, people who have an ACL injury often say that their knee has “given out” from under them.
As a result, abnormal veins that cause varicocele can be correctly identified and successfully closed in the same session while the normal veins that have a good function are not touched. Conditions that make a rupture more likely include the injection of steroids into a tendon, certain diseases (such as gout or hyperparathyroidism), and having type O blood.
Chondromalacia patellae can also be the result of a fall or being hit from the front, which can lead to small tears or irregularities in the cartilage. It is often a result of runner’s knee (patellofemoral pain syndrome), although each condition can occur alone. This form of arthritis involves degeneration of the all-important cartilage, and the risk of developing the disease increases with age.
If the tears are allowed to heal before you subject them to more overuse, then you have a good chance of relieving your pain. An overuse injury can be considered to be acute if it causes pain or inflammation. Acute knee injuries can also happen if you haven’t exercised for a long time and you suddenly engage in running, jumping, or other weight-bearing activities that put a lot of stress on your knees. Other advantages of embolization include use of local anesthesia, absence of complications such as infection, hydrocele and testicular damage and possibility to discharge the patient several hours after the procedure. Rheumatoid arthritis is an inflammatory type of arthritis that can destroy the joint cartilage, and it generally affects both knees. In one study, the patients who previously underwent both surgery and embolization were asked which treatment they would prefer and they all answered that they would prefer embolization (Fereley ve ark. 5C) demonstrates bone within the cage, midline positioning of the implant, with substantial endplate coverage.
Br J Urol).How is it performed?Varicocele embolization is performed by interventional radiologists using the angiography device.
This type of arthritis is similar to osteoarthritis and may occur years after a fracture, meniscus tear, or ligament injury. After the skin is numbed at the armpit or groin, a small sheath is placed into the vein under ultrasound guidance.
Occupational or recreational activities are not generally considered true risk factors for the injury.
We present a case of a patient with no known significant medical history who sustained simultaneous rupture of bilateral quadriceps tendons and left rotator cuff after using an elliptical machine daily for three months. The patient is asked to perform a Valsalva maneuver (taking a deep breath and straining) to increase the pressure in the abdomen and provoke reflux. At the same time, a special dye called contrast is injected through the catheter, serial X ray films are taken and the refluxing veins are identified on the angiograpy screen.
For the three months prior to his injury, he exercised daily on an elliptical machine for three hours per day. For this, multiple coils are first pushed through the catheter and thightly packed into the refluxing vein at two levels, and the vein is mechanically occluded. The patient missed a step while going down a stairway and felt his right knee "pop", resulting in a fall. Then, a sclerosing agent is mixed with air and turned into a “foam” and injected into the refluxing vein between the coils through the same catheter.

Attempting to recover from his fall, he felt his left knee "pop" and he fell on his left outstretched arm.
The aim of foam injection is to close small abnormal veins that might later connect varicocele to refluxing vein and cause recurrence. The stages of varicocele embolization: A sheath is placed into the vein of the armpit, the refluxing vein is identified with venography and then closed with coils and foam.
The patient can stand up and walk 10 minutes after the procedure.After the embolization, the patient is asked again to perform a Valsalva maneuver and a venography is obtained to see if there is any more refluxing vein that requires treatment.
Unable to mobilize or perform activities of daily living at home, he presented to our facility for further evaluation. If no other refluxing vein is seen the catheter and sheath is removed and the procedure is terminated.After the embolization, the puncture site is compressed with hand until the bleeding stops and a bandage is applied.
For this, the catheter is placed into the main testicular vein of the other testicle, the patient is asked to perform a Valsalva maneuver and the refluxing veins are identified on venography. In patients with bilateral varicoceles, the ideal treatment is embolization because it is possible to treat both varicoceles in the same session through the same entry site.
The advantages and disadvantages of varicocele embolizationIf the patient has bilateral (both-sided) varicoceles, the other varicocele is also treated in the same session.
On active range of motion, abduction was limited to 20 degrees, extension limited to 30 degrees and flexion limited to 30 degrees.
The advantages and disadvantages of varicocele embolizationIn a patient with left varicocele, venography shows two veins going to the testicle.
Selective venography however, shows that the thinner vein was refluxing and the larger vein has a normal function (B,C).
A magnetic resonance imaging (MRI) of the left shoulder and bilateral lower extremities demonstrated a complete rotator cuff tear and bilateral quadriceps tendon rupture (Figs. Had this patient been treated with surgery, the larger vein would have been ligated instead of the thinner vein which was abnormal. Thus, the varicocele would have been persisted after the operation and a normal vein would have been ligated for nothing.During the surgery, the veins are seen and tied up from outside and thus, there is always the risk of ligating other vessels unintentionally including the normal veins, arteries and lymphatic channels. In contrast, since embolization is performed inside the veins it is impossible to go out of the vein and harm the other vessel systems such as arteries and lymphatics.
For this reason, testicular loss due to arterial damage or hydrocele due to closure of the lymphatic channels are never seen in embolization.In both-sided varicocele, treatment can be performed in the same session through the same skin entry site. After embolization, patIn embolization, patients may leave the hospital a few hours after the procedure, while in surgery hospitalization is generally required. After immobilization for 12 weeks, he was admitted to the inpatient rehabilitation unit for aggressive physiotherapy.
On discharge from the rehabilitation unit, the patient was ambulatory with a front wheel walker and independent with functional transfers.
Presenting symptoms vary and it is often difficult to examine the patient due to pain and swelling, as in our case. Diagnosis is often delayed or missed, with a reported diagnostic delay in 38.7% of patients and missed diagnosis in 50% of patients on initial evaluation (3, 4). The patient suffered a diagnostic delay of three days after being sent home by an outside hospital, which stresses the importance of consideration of tendon injury as a differential diagnosis. A previous review of the literature indicated that 67.9% of patients with bilateral quadriceps tendon rupture sustained an injury at an additional site (2). None of these reported patients presented with concurrent rotator cuff tear, and neither did the index patient.
Chronic renal failure is considered to be the most common risk factor, with a reported rate of over 40% (1).
Previous speculation regarding development of quadriceps tendon lesions from overuse has been suggested by other researchers (5, 6).
His presentation suggests that chronic overuse of the tendon from intensive elliptical training resulting in microtrauma, may be a true risk factor for quadriceps tendon rupture. It also emphasizes the importance of considering bilateral quadriceps tendon rupture as a differential diagnosis.

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