Common Flexor Tendon Tear Following Yoga and Local Corticosteroid Injections: A Case Report

Abstract

KEY WORDS elbow, sport, tendon Severe tearing of the tendons around the elbows is rare, even in athletes; especially tearing of the common flexor tendon of the wrist. We report the case of a 52-year-old housewife who complained of bilateral medial elbow pain after forcefully extending her wrist and elbow while practicing yoga. Repeated corticosteroid injections were administered over her right medial elbow at an orthopedic clinic. Her pain was relieved temporarily but recurred later. She visited our rehabilitation outpatient department, and physical examination revealed weakness during right wrist flexion and forearm pronation. Hence, sonography was performed, which showed a hypoechoic area and soft tissue indentation within the right common flexor tendon. Subsequent magnetic resonance imaging revealed a focal area with a hyperintense signal around the medial epicondyle on fast short-inversion-time inversion recovery images. Both imaging studies indicated a complete tear of the common flexor tendon, and surgical exploration confirmed the imaging findings. We speculated that the infrequent presentation of a medial elbow injury may be attributable to preceding valgus stress and eccentric loading of the elbow during yoga and further tendon weakening after repeated corticosteroid injections. ª

Adverse Events Associated with Yoga: A Systematic Review of Published Case Reports and Case Series

“…Of the included 37 reports, 19 originated from the USA [28], [31]–[33], [35], [38]–[40], [43]–[47], [49], [52], [55]–[57], [61], 1 from Canada [60], 2 from the UK [51], [59], 1 from Germany [42], 1 from Switzerland [25], 2 from Italy [26], [34], 1 from Denmark [36], 5 from India [29], [41], [48], [53], [54], and 1 each from Nepal [27], China [37], Taiwan [58], South Korea [30], and Australia [50]. The first included report was published in 1969, the number of reports published each year gradually increased until 2012 (Figure 2).…”

“…Kneeling posture (Vajrasana) [31], locust pose (Salabhasana) [36], bridge pose (Setu bandha) [49], seated forward bend (Paschimottasana) [57], and downward-facing dog (Adho mukha savasana) [58] were practiced in 1 case each. One case of a female teenager was reported to have practiced “voluntary mouth-to-mouth Yoga breathing exercises with a teenage boy” [33].…”

“…Another case was reported doing “extreme yoga postures” that were not further characterized [29]. In 10 cases, the yoga practice that was associated with the adverse event was practiced under supervision [26], [42], [43], [45], [51], [54], [56], [58], [59], [61], in 4 cases it was unsupervised [33], [53], [55], [61]. The remaining reports did not state whether the practice was supervised or not.…”

“…In 27 cases, adverse events affected the musculoskeletal system and included fractures [26], [60], [61], ligament tears [50], [58], [60], joint injuries [60], fibrocartilaginous injuries [60], lumbar disc annular tears [60], myositis ossificans [44], and increased muscle enzymes [55]. Nine cases reported orbital adverse events including acute glaucoma [36], [52], worsening of chronic glaucoma [25], [35], [38], and orbital varices or vein occlusion [32], [46], [49], [53].…”

“…Fifteen cases reached full recovery without [25] or after adequate treatment [29]–[31], [36], [40], [44], [45], [48], [50], [51], [54], [55], [57], [59] and 9 cases reached partial recovery [27], [34], [37], [39], [43], [49], [52], [56], [58]. One case did not reach any recovery [53] and 1 case died [33].…”