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Journal of Ultrasound

, Volume 17, Issue 2, pp 165–167 | Cite as

Complete Achilles tendon rupture after local infiltration of corticosteroids in the treatment of deep retrocalcaneal bursitis

  • Ganfranco Vallone
  • Tarallo VittorioEmail author
Case Report

Abstract

Complete rupture of the Achilles tendon is relatively rare, but it is an injury of considerable clinical relevance. A common cause of non-traumatic tendon rupture is local corticosteroid infiltration. Corticosteroid injections may start a degenerative process resulting in partial rupture and subsequent complete rupture of the tendon due to a direct toxic effect, because corticosteroids inhibit production of extracellular matrix collagen and also because of poor local vascularization. This paper describes the case of a patient who presented with complete rupture of the Achilles tendon shortly after administration of local corticosteroid injections in the treatment of deep retrocalcaneal bursitis. This confirms that corticosteroid treatment which is not correctly and accurately administered may be a factor contributing to major injury. It demonstrates that the physician must take all necessary precautions when administering corticosteroid infiltration. It is particularly important that corticosteroid injection is performed under ultrasound guidance which permits visualization of the needle tip and therefore exact identification of the injection site.

Keywords

Achilles tendon Ultrasound Corticosteroid injections 

Riassunto

Le rotture complete del tendine d’Achille sono piuttosto rare, ma hanno una notevole rilevanza clinica. Tra le cause atraumatiche di rottura sono abbastanza frequenti quelle che riconoscono come concausa i trattamenti infiltrativi locali di corticosteroidi. Questi, sia con un’azione tossica diretta, sia con l’inibizione sulla produzione della matrice extracellulare del collagene, sia con una riduzione della vascolarizzazione locale, determinano un processo degenerativo che progredendo determina dapprima una lesione parziale e poi una rottura completa del tendine. Il caso riportato si riferisce ad una paziente che, per il trattamento di una borsite retrocalcaneale profonda, veniva trattata con terapia infiltrativa locale con cortisone e, a breve distanza di tempo, presentava una rottura completa del tendine d’Achille; è esplicativo come un trattamento terapeutico con corticosteroidi, eseguito in maniera non del tutto corretta, possa essere concausa di lesioni importanti. E’ indicativo del fatto che sia necessario rispettare tutte le precauzioni quando si procede a terapia infiltrativa locale di corticosteroidi, in particolare come sia importante iniettare sotto guida ecografica perché ciò consente di valutare in tempo reale la posizione della punta dell’ago e quindi di conoscere esattamente la sede di iniezione.

Notes

Conflict of interest

Gianfranco Vallone and Vittorio Tarallo declare that they have no conflict of interest related to this paper.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. The patient provided written informed consent to the publication of this paper and to the inclusion in this article of information that could potentially lead to her identification.

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Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2014

Authors and Affiliations

  1. 1.Department of Diagnostic Imaging and RadiotherapyUniversity Federico IINaplesItaly
  2. 2.Institute of Radiology, The IRCCS Foundation Policlinico San MatteoUniversity of PaviaPaviaItaly

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