title: Bilateral Quadriceps Femoris Tendon Rupture in a Patient With Chronic Renal Insufficiency: A Case Report.
abstract: BACKGROUND
  Simultaneous bilateral quadriceps femoris tendon rupture is a relatively rare occurrence. As such, patients frequently experience a delay in receiving an accurate diagnosis. It is often associated with significant morbidity and loss of function. We report a case of simultaneous bilateral quadriceps tendon ruptures in a patient with chronic renal insufficiency.
  
  
  METHODS
  A 46-year-old white man presented to the Emergency Department (ED) via ambulance, reporting sudden onset of bilateral lower limb weakness. He had a medical history of renal insufficiency due to immunoglobulin-A-induced glomerulopathy, with secondary hyperparathyroidism and gout. Examination of his lower limbs revealed significant swelling in his distal thighs anteriorly and suprapatellar defects at the insertion of the quadriceps tendon. No other palpable deficits were identified. The patella was in a normal position and there was minimal tenderness on palpation. He had complete loss of active knee extension. Bilateral patella reflexes were absent. Lower-limb sensation was intact bilaterally and no other neurovascular deficits were elicited. Thompson test was negative and the rest of the clinical examination was unremarkable. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The inability to walk is a common ED presentation. The differential diagnosis is vast and includes but is not limited to: spinal cord injury, Guillain-Barré syndrome, myopathies, and even malingering. This case report details an uncommon cause for a common ED presentation. Furthermore, this case illustrates the importance of a detailed clinical history and physical examination, which narrowed the differential diagnosis and ultimately led to the clinical diagnosis. Knowledge of the patient's past medical history combined with simple imaging modalities permitted a prompt clinical diagnosis of an uncommon condition, which facilitated early operative management.
authors.affiliation: Department of Emergency Medicine, Launceston General Hospital, Tasmania, Australia; Royal Melbourne Hospital, Victoria, Australia.
authors.forename: Chris H L
authors.initials: CH
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine, Launceston General Hospital, Tasmania, Australia.
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Landon
authors.affiliation: Department of Emergency Medicine, Launceston General Hospital, Tasmania, Australia.
authors.forename: Gar M
authors.initials: GM
authors.lastname: Chan
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D052097:Quadriceps Muscle; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012422:Rupture, Spontaneous / Q000150:complications / Q000000981:diagnostic imaging; D013708:Tendon Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D013848:Thigh
keywords: bilateral quadriceps tendon rupture; chronic renal insufficiency; quadriceps tendon; tendinopathy