Skeletal Radiology

, Volume 48, Issue 8, pp 1279–1287 | Cite as

Multiple spontaneous tendon ruptures from enthesis failure in primary hyperparathyroidism: a case report and review of imaging findings

  • Maaz Mohammad SalahEmail author
  • Yan Rong Yong
  • Wee Teng Poh
  • Le Roy Chong
Case Report


Cases of spontaneous tendon ruptures have been previously reported in the literature. Although both renal failure and hyperparathyroidism have been implicated as separate aetiologies, their frequent co-existence has confounded analysis. We report a case of a young man with primary hyperparathyroidism presenting with multiple acute spontaneous tendon ruptures. This case affords an opportunity to evaluate the imaging features of acute spontaneous tendon ruptures in the context of primary hyperparathyroidism, and in conjunction with a review of previous literature reports, an imaging-based hypothesis on the pathophysiology and aetiology of spontaneous tendon ruptures is proposed.


Primary hyperparathyroidism Spontaneous tendon rupture Enthesis failure 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Pappu R, Jabbour S, Regianto A, Reginato A. Musculoskeletal manifestations of primary hyperparathyroidism. Clin Rheumatol. 2016;35:3081–7.CrossRefGoogle Scholar
  2. 2.
    Ryuzaki M, Konishi K, Kasuga A, et al. Spontaneous rupture of the quadriceps tendon in patients on maintenance haemodialysis: report of three cases with clinicopathological observations. Clin Nephrol. 1989;32:144–8.PubMedGoogle Scholar
  3. 3.
    Thaunat M, Gaudin P, Naret C, Beaufils P, Thaunat O. Role of secondary hyperparathyroidism in spontaneous rupture of the quadriceps tendon complicating chronic renal failure. Rheumatology. 2006;45:234–5.CrossRefGoogle Scholar
  4. 4.
    Gao X, Shao Z, Liu S, Xiang J. A case report of spontaneous rupture of the quadriceps tendon. Clin Case Rep. 2017;5:1477–81.CrossRefGoogle Scholar
  5. 5.
    Uzer G, Elmadag M, Yildiz F, Pulatkan M. Simultaneous spontaneous bilateral quadriceps tendon rupture related with hyperparathyrodism secondary to vitamin D deficiency: a case report. Bezmialem Sci. 2014;1:33–6.CrossRefGoogle Scholar
  6. 6.
    Camarda L, D’Arienzo A, Morello S, Guarneri M, Balistreri F, D’Arienzo M. Bilateral ruptures of the extensor mechanism of the knee: a systematic review. J Orthop. 2017;14:445–53.CrossRefGoogle Scholar
  7. 7.
    Shah M. Simultaneous bilateral quadriceps tendon rupture in renal patients. Clin Nephrol. 2002;58:118–21.CrossRefGoogle Scholar
  8. 8.
    Kurer M, Baillod R, Madgwick J. Musculoskeletal manifestations of amyloidosis. A review of 83 patients on haemodialysis for at least 10 years. J Bone Joint Surg Br Vol. 1991;73-B:271–6.CrossRefGoogle Scholar
  9. 9.
    Ribbans W, Angus P. Simultaneous bilateral rupture of the quadriceps tendon. Br J Clin Pract. 1989;43:122–5.PubMedGoogle Scholar
  10. 10.
    Hofmann G, Weber T, Lob G. Tendon rupture in chronic kidney insufficiency—‘uremic tendonopathy’? A literature-supported documentation of 3 cases. Chirurg. 1990;61:434–7.PubMedGoogle Scholar
  11. 11.
    De Franco P, Varghese J, Brown W, Bastani B. Secondary hyperparathyroidism, and not β2-microglobulin amyloid, as a cause of spontaneous tendon rupture in patients on chronic hemodialysis. Am J Kidney Dis. 1994;24:951–5.CrossRefGoogle Scholar
  12. 12.
    Shiota E, Tsuchiya K, Yamaoka K, Kawano O. Spontaneous major tendon ruptures in patients receiving long-term hemodialysis. Clin Orthop Relat Res. 2002;394:236–42.CrossRefGoogle Scholar
  13. 13.
    Malta L, Gameiro V, Sampaio E, Gouveia M, Lugon J. Quadriceps tendon rupture in maintenance haemodialysis patients: results of surgical treatment and analysis of risk factors. Injury. 2014;45:1970–3.CrossRefGoogle Scholar
  14. 14.
    Wani N, Malla H, Kosar T, Dar I. Bilateral quadriceps tendon rupture as the presenting manifestation of chronic kidney disease. Indian J Nephrol. 2011;21:48–51.CrossRefGoogle Scholar
  15. 15.
    Chen C, Wang S, Wu S, Chu P, Huang G. Spontaneous rupture of the patellar and contralateral quadriceps tendons associated with secondary hyperparathyroidism in a patient receiving long-term dialysis. J Formos Med Assoc. 2006;105:941–5.CrossRefGoogle Scholar
  16. 16.
    Gao M, Yang H, Shi W. Simultaneous bilateral quadriceps tendon rupture in a patient with hyperparathyroidism undergoing long-term haemodialysis: a case report and literature review. J Int Med Res. 2013;41:1378–83.CrossRefGoogle Scholar
  17. 17.
    Seng C, Lim Y, Pang H. Spontaneous disruption of the bilateral knee extensor mechanism: a report of two cases. J Orthop Surg. 2015;23:262–6.CrossRefGoogle Scholar
  18. 18.
    Sterne G, Richardson M, Warren B. Imaging findings in two cases of fluoroquinolone-induced Achilles tendinopathy. Radiol Case Rep. 2006;1:87–91.CrossRefGoogle Scholar
  19. 19.
    Abduljabbar F, Aljurayyan A, Ghalimah B, Lincoln L. Bilateral simultaneous quadriceps tendon rupture in a 24-year-old obese patient: a case report and review of the literature. Case Rep Orthop. 2016;2016:1–6.CrossRefGoogle Scholar
  20. 20.
    Vallone G, Vittorio T. Complete Achilles tendon rupture after local infiltration of corticosteroids in the treatment of deep retrocalcaneal bursitis. J Ultrasound. 2014;17:165–7.CrossRefGoogle Scholar
  21. 21.
    McMullen T, Bodie G, Gill A, et al. Hyperparathyroidism after irradiation for childhood malignancy. Int J Radiat Oncol Biol Phys. 2009;73:1164–8.CrossRefGoogle Scholar
  22. 22.
    Szalat A, Mazeh H, Freund H. Lithium-associated hyperparathyroidism: report of four cases and review of the literature. Eur J Endocrinol. 2009;160:317–23.CrossRefGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • Maaz Mohammad Salah
    • 1
    Email author
  • Yan Rong Yong
    • 1
  • Wee Teng Poh
    • 2
  • Le Roy Chong
    • 1
  1. 1.Department of RadiologyChangi General HospitalSingaporeSingapore
  2. 2.Department of PathologyChangi General HospitalSingaporeSingapore

Personalised recommendations