Isolated spontaneous pectoralis minor tendon rupture in a patient with chronic renal failure

Abstract

Isolated rupture of the pectoralis minor tendon is extremely rare and has been reported 3 times in 4 patients. This article describes the first case of an isolated spontaneous pectoralis minor tendon tear in an endstage renal disease (ESRD) patient undergoing long-term hemodialysis and with a previous history of bilateral rupture of the quadriceps tendons.He presented with left anterior shoulderand chest wall pain with direct tenderness on palpation over the coracoid. Magnetic resonance imaging revealed an isolated tear of the pectoralis minor tendon with an intact pectoralis major tendon. The patient returned to full activities after conservative management. Although rare, the diagnosis of pectoralis minor tendon rupture should be considered in ESRD patients who present with anterior shoulder pain in the absence of an antecendent trauma.Key Words: End-Stage Renal Disease, Pectoralis Minor, Tendon Rupture, HemodialysisPektoralis minör tendonunun izole rüptürü son derece nadirdir ve 4 hastada 3 kez bildirilmiștir. Bu makale uzun süredir hemodiyalize giren ve bilateral kuadriseps tendonlarında rüptür hikayesi olan, son dönem böbrek yetmezliği (SDBY) bulunan hastadaki ilk izole spontan pektoralis minör tendon rüptürüdür. Hasta sol ön omuz ve korakoid üzerinde palpasyonla hassasiyet veren göğüs ön duvarı ağrısıyla bașvurdu. Manyetik rezonans görüntülemede sağlam pektoralis major tendonuyla birlikte pektoralis minör tendonu izole rüptü-rü mevcuttu. Hasta konservatif tedavi sonrası eski aktivite düzeyine döndü. Nadir olmakla birlikte pektoralis minör tendon rüptürü tanısı ön omuz ağrısıyla bașvuran, öncesinde travma öyküsü olmayan SDBY hastalarında düșünülmelidir.Anahtar Sözcükler: Son Dönem Böbrek Yetmezliği, Pektoralis Minör, Tendon Rüptürü, Hemodiyaliz Spontaneous rupture of tendons (quadriceps, Achilles and patellar tendon) is a clinical entitHy that is commonly reported to occur during the course of chronic diseases including the endstage renal disease (ESRD), diabetes mellitus, systemic lupus erythematosus and treatment with corticosteroids, statins and the fluoroquinolone antibiotics (1-4). Isolated spontaneous rupture of the pectoralis minor tendon without the pectoralis major tendon tear is extremely rare (5-8). Those reported cases were healthy people and had an antecedent trauma. Literature search on PubMed and MED-LINE revealed no reported case of isolated spontaneous pectoralis minor tears in chronic diseases. Herein, we report an isolated spontaneous rupture of the pectoralis minor tendon in an ESRD patient undergoing longterm hemodialysis and with a previous history of bilateral rupture of the quadriceps tendons. Case ReportA-59-year-old male presented with left anterior shoulder and chest wall pain. His pain worsened on abduction and extension of the arm beyond the scapular plain. He had type 1 diabetes mellitus, ESRD secondary to diabetic nephropathy and has been on hemodialysis for the last 9 years. Simultaneous rupture of quadriceps tendons occurred after a minor trauma within the last year. He unde...