Simultaneous Bilateral Rupture of Achilles Tendons Due to Triamcinolone

Abstract

COMMENT Spontaneous rupture of tendons may result from pyogenic infection, tuberculosis, gonorrhoea, syphilis, gout, or tumours (Boyd, 1938), and is seen not infrequently as a part of the clinical picture of rheumatoid arthritis.In the latter condition the tendons undergo fibrinoid degeneration, a characteristic of the collagen diseases.It is possible that in the present case the pain prior to the final tendon rupture was due to minute tears in the degenerating tendon, and that normal healing was inhibited by the steroid therapy.In an experimental study Wrenn, Goldner, and Markee (1954) showed that, though end-to-end healing of ruptured tendons in animals on cortisone therapy was not prevented, the tendons were 40% weaker than control tendons.The cortisone delayed the maturation of the fibrous tissue.The ease with which the tendons ruptured in the present case and the relative lack of pain at the time would indicate that they were grossly degenerated.A similar picture is seen at the shoulder, where again a large tendon mass is involved.In the older age-group rupture of the supraspinatus tendon occurs with rela- tively little trauma and minimal pain.In a slightly younger age-group chronic tendinitis is seen which is painful and may be the sequel to a partial tear (Apley, 1959).This would perhaps correspond to the pain in the present case during the four months before the tendons ruptured.