Achilles tendon

Tendinitis is an inflammatory painful tendon disorder which can be caused by quinolones. Typical cases are characterized by acute onset, palpation and sharp pain mostly of one or both Achilles tendons, but other tendons may also be affected. Magnetic resonance imaging (MRI) is used to support the diagnosis. Estimates for the incidence of quinolone-induced tendinitis range from approximately 1 100 to 1 10,000. The etiology remains unknown, concomitant... 

All fluoroquinolone drugs can cause pain, inflammation, or rupture of a tendon. The Achilles tendon is particularly vulnerable. This problem can be so severe tiiat prolonged disability results, and, at times, surgical intervention may be necessary to correct die problem, hi addition, the fluoroquinolone drugs, particularly sparfloxacin and lomefloxacin, cause dangerous photosensitivity reactions. Fhtients have experienced severe reactions even when sunscreens or sunblocks were used. 

EDMD is another X-linked muscular dystrophy, clinically and genetically completely distinct from DMD and BMD. Affected boys usually have onset in childhood of contractures (especially involving the Achilles tendons, elbows, and spinal muscles), humeroperoneal muscle weakness, and cardiac conduction defects, which tend to be mostly a problem in adult life and may necessitate insertion of a pacemaker. The gene for EDMD is known to map to Xq28, but this localization is... 

Patients with genetic disorders that cause a marked increase in serum LDL cholesterol (greater than 250 mg/dL [6.48 mmol/L]) may present with corneal arcus of the eye and xanthomas of extensor tendons of the hand and Achilles tendon. 

Mazzone MF, McCue T. Common conditions of the achilles tendon. 

Fluoroquinolones Tendonitis, Achilles tendon rupture, contraindicated... 

Tophi (urate deposits) are uncommon in gouty subjects and are a late complication of hyperuricemia. The most common sites of tophaceous deposits in patients with recurrent acute gouty arthritis are the base of the great toe, helix of the ear, olecranon bursae, Achilles tendon, knees, wrists, and hands. 

At one end of the scale are those individuals who lack all sensitivity to the usual pain stimulibums, cuts, bruises, etc. Such a person was a boy at Johns Hopkins who could have pins thrust into him his skin could be pinched until it became bloodshot his Achilles tendon could be squeezed with full force without any indication of discomfort. He did have a normal sense of touch and was sensible to cold and heat throughout his body surface, but nowhere was there a response to pain. 

Ila i i j i Familial hypercholesterolemia Autosomal dominant (Aa 1/500, AA 1/10 ) Cholesterol LDL High risk of atherosclerosis and coronary artery disease Homozygous condition usually death <20 years Xanthomas of the Achilles tendon Tuberous xanthomas on elbows Xanthelasmas Comeal arcus... 

Running economy, an index of the contribution to performance made by the springs, the Achilles tendon and the arch of the foot, was better in the Kenyans. 

While the dose-limiting toxicity for vinblastine usually is leukopenia, that for vincristine is most commonly neurotoxicity (58). Prominent manifestations of neurotoxicity are loss of the Achilles tendon reflex, paresthesias, loss of muscle strength (e.g., in the foot and wrist), and ataxia. Constipation and abdominal pain may occur and are thought to result, at least in part, from actions on the autonomic nervous system. Leukopenia and stomatitis are possible effects of vincristine treatment, but they occur relatively infrequently. Alopecia occurs with vincristine at a frequency comparable to that observed with vinblastine, and vincristine also is a potent tissue irritant. Vincristine may produce a syndrome of inappropriate secretion of antidiuretic hormone, and some manifestations of neurotoxicity, such as seizures, have been considered to be due to electrolyte disturbances associated with the relative excess of the antidiuretic hormone (58). 

Tendon rupture/Tendinitis Ruptures of the shoulder, hand, and Achilles tendons that required surgical repair or resulted in prolonged disability have been reported with fluoroquinolone antimicrobials. 

Young RG, Butler DL, Weber W, Caplan AI, Gordon SL, Fink DJ. Use of mesenchymal stem cells in a collagen matrix for Achilles tendon repair. J Orthop Res 1998 16 406 13. 

Tendon effects, including ruptures of shoulder, hand, Achilles tendon or other tendons, may occur. Risk increases with concomitant corticosteroid use, especially in the elderly. 

Fluoroquinolones Tendonitis, Achilles tendon rupture, contraindicated in patients less than 18 years old because of effects on cartilage development... 

In poultry, manganese deficiency causes a different clinical picture when it affects the egg than when it affects the hatched bird In the case of the egg, the embryo become swollen and deformed, and their skeletons become defective and fragile [ chondrodystrophy"). Adult birds develop perosis (slipped tendon) which is an enlargement and malfunction of the libiiil metatarsal joint, followed hy slipping of the Achilles tendon from the condyles. The bone deformities seen in poultry also can be induced in mammals. 

Tendons can be injured by glucocorticoids and can rupture (276). Ten cases of Achilles tendon rupture were seen in a single clinic over a 10-year period (SEDA-17, 448). The risk seems to be greater if local (for example intra-articular) injections are used. 

A 69-year-old man with newly diagnosed giant cell arteritis was given prednisone 30 mg bd, and 2 weeks later developed severe pain along his Achilles tendons bilaterally 1 week later the left tendon ruptured (278). Despite immobilization his pain worsened. The prednisone was gradually tapered and the symptoms abated, with complete recovery. 

Bunch TJ, Welsh GA, Miller DV, Swaroop VS. Acute spontaneous Achilles tendon rupture in a patient with giant cell arteritis. Ann Clin Lab Sci 2003 33 326-8. 

A 28 year-old woman with Kearns-Sayre Syndrome, previously exposed multiple times to lidocaine, underwent planned tooth extraction after injection of articaine 1.5 ml (60 mg) with adrenaline (0.009 mg) (168). Within 5 minutes she complained of a feeling of heat, fatigue, weakness, and a desire to sleep. She was unable to walk or stand and had frequent urination. At 20 hours after the injection she had diffuse weakness, reduced tendon and absent patellar reflexes, and sub-clonic Achilles tendon reflexes. She recovered fully 48 hours after the injection. 

Figure 3.29. Relationship between proteoglycans and collagen fibrils in tendon. Transmission electron micrograph showing positive staining pattern of type I collagen fibrils from rabbit Achilles tendon stained with quinolinic blue. Proteoglycan filaments (arrows) are shown attached to collagen fibrils.

In particular, the gastrocnemius, or Achilles tendon structure of the domestic turkey and manner of mineralization tendon have been described... 

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