Last month's case highlighted a male patient presenting with sudden severe pain of the left biceps when he was on the commode and tried to shut a door with his left arm. A hematoma was noticed afterward.

The question was:

The following are risk factors for recurrent tendons rupture, except:

1. Chronic steroid therapy

2. Inflammatory arthritides

3. Lisinopril

4. Fluoroquinolones

5. Repeated trauma to the joints

The Correct Answer is 3. Lisinopril

Tendon rupture spontaneously or with minimal trauma is rare and multifactorial. Most of the time no cause is recovered, and rupture may have a genetic predisposition.

Risk factors include:

• Trauma

• Chronic medical conditions: chronic renal failure, diabetes mellitus, and hyperparathyroidism

• Systemic steroids

• Fluoroquinolones

• Aromatase inhibitors: anastrazole (estrogen positive breast cancer)

Genetic predisposition and collagen disorders, such as collagen VI and Lamin A/C mutations are rare but important causes. In these cases, some degree of muscle weakness, contractures, joint hyperextensibility, and increased skin elasticity would be expected.

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Aziz Shaibani, MD, FACP, FAAN, FANA is Director of the Nerve & Muscle Center of Texas. He is also Clinical Professor of Medicine at Baylor College of Medicine in Houston, and an Adjunct Professor of Neurology at Kansas University Medical Center in Kansas City.