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Rheumatology 2006 45(5):594; doi:10.1093/rheumatology/kei222
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

CLINICAL VIGNETTE

Proximal muscle weakness and elevated creatinine kinase

A. Al-Ansari1, C. Clarke2 and G. Kallarackal1

1 Kettering General Hospital, Rheumatology, Kettering, Northamptonshire, 2 Kettering General Hospital, Radiology, Kettering, Northamptonshire, United Kingdom

Correspondence to: A. Al-Ansari. E-mail: atheeralansari{at}yahoo.co.uk

A 67-yr-old lady was admitted with proximal muscle weakness and painful lower limbs. Her symptoms developed suddenly when rising from the toilet chair. Examination confirmed the proximal weakness in the lower limbs, with no other significant neurological abnormality. Her past medical history was of chronic renal impairment secondary to hypertension, which was managed conservatively. She is not diabetic or on steroid therapy. Blood tests showed urea 14.3 mmol/l and creatinine 181 mmol/l; creatinine kinase (CK) was 9463 IU/l (normal values <200 IU/l).

MRI showed high signal changes within the biceps femoris muscles bilaterally, indicating trophic changes after the rupture. In addition there were small avulsion fractures present at the origin of the long head of the biceps in the region of the ischial tuberosities.

The patient recovered with physiotherapy and her CK level normalized over 1 week.

Spontaneous muscle rupture is rare but is a well-recognized manifestation, particularly in elderly or obese people, in patients on long-term steroid therapy, in metabolic diseases [1, 2] such as hyperparathyroidism and diabetes mellitus, and in chronic renal failure [3].

Muscle rupture in renal failure is either due to muscle degeneration related to acidosis or due to secondary hyperparathyroidism, which leads to bone resorption and avulsion of the muscle attachment.

The authors have declared no conflicts of interest.

References

  1. Alpantaki K, Papadokostakis G, Katonis P, Hadjpavlou A. Spontaneous and simultaneous bilateral rupture of the quadriceps tendon. A case report. Acta Orthop Belg 2004;70:76–9.[Medline]
  2. Quintero Quesada J, Mora Villadeamigo J, Abad Rico JI. Spontaneous bilateral patellar tendon rupture in an otherwise healthy patient. A case report. Acta Orthop Belg 2003;69:89–92.[Medline]
  3. Bhole R, Flynn JC, Marbury TC. Quadriceps tendon ruptures in uremia. Clin Orthop Relat Res 1985;195:200–6.

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