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Quadriceps tendonitis icd 10 code for hypothyroidism: The increasing incidence of surgically treated quadriceps tendon ruptures

The ICD code S is used to code Patellar tendon rupture Patellar tendon rupture is a rupture of the tendon that connects the patella to the tibia. Above the patella are the quadriceps muscle large muscles on the front of the thigh , the quadriceps tendon attaches to the top of the patella.

Lucas Cox
Monday, September 3, 2018
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  • During the study period, QTR surgeries were performed.

  • Complete quadriceps tendon tears are unusual injuries.

  • Since these are incompletely recorded in the database, it was not possible to investigate the effects of comorbidities on the incidence of QTRs, of which diabetes and endocrine diseases would have been of most interest.

Strain of unspecified quadriceps muscle, fascia and tendon, initial encounter

Surgical management of acute quadriceps tendon rupture a case report with literature review. Note 2 : For chronic residuals, rate under diagnostic code Epstein-Barr virus; HIV; influenza.

Toggle navigation ICD. Focal, periarticular, or diffuse. Facial weakness; fatigable weakness; ptosis. Otherwise, electromyography is indicated to confirm the presence of a myopathy or to evaluate for a neuropathy or a disease of the neuromuscular junction.

Bannwarth B. Lacomis D. Alcohol; amyloid; glycogen storage disease; inflammatory myopathies; muscular dystrophies; sarcoid. To code a diagnosis of this type, you must use one of the three child codes of S J Allergy Clin Immunol.

Differential Diagnosis

It can be postulated that a more active lifestyle plays a less important role in the changing epidemiology of QTR compared with that of ATR. Etiology, diagnosis and treatment of tendinous knee extensor mechanism injuries. Extensor mechanism injuries of the knee: demographic characteristics and comorbidities from a review of patient records. Published online Mar

Myophosphorylase deficiency. The combined range of motion refers quadriceps tendonitis icd 10 code for hypothyroidism the sum of the range of forward flexion, extension, left and right lateral coed, and left and right rotation. Next, investigations looking for inflammatory, rheumatologic, or genetic myopathies can be performed sequentially or concurrently. Vance ML. X-rays can help your doctor determine if the kneecap was damaged. The key to differentiating this is whether or not the tendon is completely torn away from the kneecap. Despite these generalizations, there is considerable variation in the time courses of different classes of myopathy, and even within the individual disorders.

If infectious disease is suspected, appropriate titers quadriiceps cultures should be obtained. A more recent article on muscle weakness in adults is available. If either ESR or ANA assay is positive, additional studies may be obtained, including rheumatoid factor rheumatoid arthritis ; anti—double-stranded DNA or antiphospholipid antibodies lupus ; or anticentromere antibodies scleroderma. Request Dataset Contact us Sign in. Evaluate residuals of incomplete traumatic paralysis under the appropriate diagnostic code e.

Injury of muscle, fascia and tendon at hip and thigh level

During our study, the number of annual TKAs performed in Finland increased from in to 10, in [ 18 ]. References 1. At present, there is a scarcity of literature on the incidence of QTR.

Usually has associated comorbidities cardiovascular disease, diabetes. As with electromyography, patients should avoid using anticoagulants before the procedure, and the site chosen for biopsy should be free of overlying infection. Use a child code to capture more detail. Cerebrovascular disease. Clinical presentation of the idiopathic inflammatory myopathies.

  • Funding No funding was received for this work.

  • Get immediate access, anytime, anywhere. Amputations: Lower Extremity.

  • Ville M.

  • Metabolic storage myopathies tend to be associated with only mild to moderate elevations in CK levels. Impairment hypothyroidsim one extremity Impairment of other extremity Anatomical loss or loss of use below elbow Anatomical loss or loss of use below knee Anatomical loss or loss of use above elbow preventing use of prosthesis Anatomical loss or loss of use above knee preventing use of prosthesis Anatomical loss near shoulder preventing use of prosthesis Anatomical loss near hip preventing use of prosthesis Anatomical loss or loss of use below elbow M Codes M-1 a, b, or c, 38 CFR 3.

The pattern is important. Nori S. Subacute onset may implicate drugs, electrolytes, or inflammatory or rheumatologic disease. Code Type.

The following code s above M No randomised clinical trials RCT that have compared icd code surgical treatment methods have been published. The ofr incidence of quadriceps tendon repairs perpersons was calculated. In our study, the mean age of the male patients sustaining a QTR increased from Twenty-five-year trends in physical activity of to year-old populations in eastern Finland. Materials and methods The Finnish National Hospital Discharge Register NHDR provides data on the age, sex, domicile of the subject, length of stay, primary and secondary diagnoses, and associated surgical procedures for all in-patient and hospital visits in Finland.

Associated Data

Level of evidence IV. Results In total, QTR surgeries were performed on patients during the study period. All adult patients aged 18 years or over who had been discharged between and were included. The major etiological factors that have been suggested to explain these changes are an increase in life expectancy and a more active life style [ 13 ]. Therefore, these two rupture types must be considered as different entities.

Buffalo hump; striae; osteoporosis. Sexually transmitted disease. Multiple sclerosis. The Knee and Leg. Type 2 Excludes injury of muscle, fascia and tendon at lower leg level S86 sprain of joint and ligament of hip S Sign Quadriceps tendonitis icd 10 code for hypothyroidism. Rating Plantar fasciitis: No relief from both non-surgical and surgical treatment, bilateral 30 No relief from both non-surgical and surgical treatment, unilateral 20 Otherwise, unilateral or bilateral 10 Note 1 : With actual loss of use of the foot, rate 40 percent Note 2 : If a veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 percent or 30 percent criteria, whichever is applicable Flatfoot, acquired: Pronounced; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances Bilateral 50 Unilateral 30 Severe; objective evidence of marked deformity pronation, abduction, etc.

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The skeletal examination may reveal the leg bowing and pseudofractures of gendonitis or the symmetric joint swelling of lupus and rheumatoid arthritis. Patellar tendon rupture showing a marked distance between the tibial tuberosity and the bottom of the patella. Preventive Services Task Force. Organophosphate intoxication. Focal processes those that are unilateral or involve specific nerve distributions or intracranial vascular areas tend to be neurologic—although not all neurologic processes are focal—and may require a different approach than that used with global strength loss.

M63 Disorders of muscle in diseases classified elsewhere. VM and AL participated in the design of the study. A- complications of pregnancy, childbirth and the puerperium OO9A congenital malformations, deformations, and chromosomal abnormalities QQ99 endocrine, nutritional and metabolic diseases E00 - E88 injury, poisoning and certain other consequences of external causes ST88 neoplasms CD49 symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified R00 - R Level of evidence IV. Clin Orthop Relat Res.

Other specified injury of quadriceps muscle, fascia and tendon

Increasing incidence of rotator cuff repairs—a nationwide registry study in Finland. Tendon degeneration is correlated with chronic illnesses, such as diabetes, hyperlipidemia, and thyroid disorder [ 2914 ]. The more active life style of older patients may have also contributed to the findings in our study.

The Hypothyroidism. The prerequisite for this historical rating is an established recurrent osteomyelitis. Causes of Rupture. Rating Plantar fasciitis: No relief from both non-surgical and surgical treatment, bilateral 30 No relief from both non-surgical and surgical treatment, unilateral 20 Otherwise, unilateral or bilateral 10 Note 1 : With actual loss of use of the foot, rate 40 percent Note 2 : If a veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 percent or 30 percent criteria, whichever is applicable Flatfoot, acquired: Pronounced; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances Bilateral 50 Unilateral 30 Severe; objective evidence of marked deformity pronation, abduction, etc. Pathologic evaluation of the muscle tissue specimen focuses on histologic, histochemical, electron microscopic, biochemical, and genetic analyses; advances in technique have made a definitive diagnosis possible for many myopathies. The quadriceps tendon ruptures typically occur during an eccentric contraction where the quadriceps muscle is contracting, but the knee is being straightened. Focal processes those that are unilateral or involve specific nerve distributions or intracranial vascular areas tend to be neurologic—although not all neurologic processes are focal—and may require a different approach than that used with global strength loss.

  • The average change in the number of surgically treated QTRs was estimated using both negative binomial and Poisson regression.

  • The Coccyx.

  • Am J Sports Med.

  • Tendon degeneration is correlated with chronic illnesses, such as diabetes, hyperlipidemia, and thyroid disorder [ 2914 ].

Tampere: Finnish Diabetes Association; One likely explanation for the increase in the mean age of patients sustaining an ATR is the growing number of older patients participating in high-demand sports [ 13 ]. Huttunen et al. Thirty-year trends of physical activity in relation to age, calendar time and birth cohort in Finnish adults. Foot Ankle Int. The majority of the observed three-to-fivefold increase in incidence is, therefore, likely due to other factors.

Gottron papules; heliotrope rash; calcinosis; interstitial lung disease; disordered GI motility. Only joints in these positions are considered to be in favorable position. Sign Up. Because of this variability, the pattern of muscle weakness is crucial in differentiating the etiology. SA Diagnosis Strain of right quadriceps muscle, fascia and tendon, init Strain of right quadriceps muscle, fascia and tendon, initial encounter. J Am Coll Surg.

Strain of quadriceps muscle, fascia and tendon

Note: dots are included. The Ribs. Sign up for the free AFP email table of contents. Note 2 : For chronic residuals, rate under diagnostic code Type 2 Excludes injury of muscle, fascia and tendon at ankle S

  • The annual number of surgeries varied from 22 to median

  • A deceptive case of amyloid myopathy: clinical and magnetic resonance imaging features. This content is owned by the AAFP.

  • Repairs of the patellar tendon are not assigned to these codes, since they have their unique codes, namely NGL30 Repair or re-insertion of the patellar tendon. Naturally, a fall that results in QTR could very well happen during high-demand sports also.

  • Quadriceps tendon rupture after total knee arthroplasty. For example, the incidence of ATR has increased in recent years [ 8101116 ], and this increase is especially prevalent in older patients [ 811 ].

  • Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study. The average yearly increase in the number of surgeries was 9.

Best Value! Variable, may have cardiac abnormalities. J Am Coll Surg. Pulmonary testing may reveal the crackles of a restrictive lung defect, found in some inflammatory and rheumatologic myopathies. Facial weakness; fatigable weakness; ptosis. Causes of Rupture.

In total, 9 out of 10 QTRs occurred in male patients. The average age of the patients also increased. Ibounig T, Simons TA. The rupture commonly follows a sudden contracture of the quadriceps muscle, although spontaneous ruptures do occur [ 12 ]. To calculate the incidence rate of quadriceps tendon repairs, the annual adult population living in Finland was obtained from the online registry maintained by Official Statistics of Finland.

Other and unspecified myopathies

Elevated urine-free cortisol, dexamethasone suppression, or corticotropin-releasing hormone stimulation tests. Peripheral neuropathy. Sarcoidosis: immunology, rheumatic involvement, and therapeutics. SA Diagnosis Strain of right quadriceps muscle, fascia and tendon, init Strain of right quadriceps muscle, fascia and tendon, initial encounter.

Human immunodeficiency virus. Acute onset may indicate infection or codw. Codes Instant Feedback. Next: Diagnosis of Gastrointestinal Bleeding in Adults. The skeletal examination may reveal the leg bowing and pseudofractures of osteomalacia or the symmetric joint swelling of lupus and rheumatoid arthritis. Usually has associated comorbidities cardiovascular disease, diabetes. ICD Code S

Variable; exercise intolerance and cardiomyopathy more common. Complete quadriceps tendon tears are unusual injuries. Easy bruising; emotional lability; obesity. The prerequisite for this historical rating is an established recurrent osteomyelitis. A diagnostic evaluation.

19. Injury, poisoning and certain other consequences of external causes (S00-T88)

Mattila quaxriceps, 3, 4 and Antti P. Whereas spontaneous QTR is usually an endpoint in the tendon degeneration process, the predisposing factors after TKA include a possible iatrogenic injury to the tendon during surgery. Diseases of the musculoskeletal system and connective tissue Note Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition.

  • In patients aged under 40 years, the increase was very subtle Fig. Distal biceps tendon ruptures: an epidemiological analysis using a large population database.

  • Read the Issue.

  • Launonen 3. National Center for Biotechnology InformationU.

  • Use a child code to capture more detail.

  • Comparison of adverse events and postoperative mobilization following knee extensor mechanism rupture repair: a systematic review and network meta-analysis. Conclusion The incidence of QTR is higher than previously reported, and it has increased steeply in recent years.

In daily life, it acts as part of the extensor mechanism to straighten the knee. ICD Code or Description. Additional note, saying whether this code is valid for submission on a UB Toggle navigation ICD. Acute weakness with neurologic deficit s.

Arthritis; malar rash; nephritis. Glycogen and lipid storage diseases; mitochondrial myopathies; myasthenia gravis. Electrodiagnostic approach to the patient with suspected myopathy. J Rheumatol.

Other specified enthesopathies of right lower limb, excluding foot

References 1. Funding No funding was received for this work. The Finnish National Hospital Discharge Register was searched for all adult patients who had undergone surgical treatment for QTR during the study period.

Amputations: Upper Extremity. Antiretroviral medications: zidovudine Retrovir ; lamivudine Epivir. Antithyroid agents: methimazole Tapazole ; propylthiouracil. Acute onset may indicate infection or stroke. To see the full article, log in or purchase access.

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On the register-based measurement of the prevalence and incidence of diabetes and its long-term complications. Introduction Along with other soft-tissue injuries that affect elderly patients, such as Achilles tendon rupture ATRpatellar tendon rupture PTRrotator cuff RC lesions, and biceps tendon rupture BTRquadriceps tendon rupture QTR can also be seen as an end stage of chronic tendon degeneration and overuse [ 1524 ]. The main limitation in our study was the lack of information regarding the possibility that the patient had undergone a total knee arthroplasty TKA. The Finnish National Hospital Discharge Register was searched for all adult patients who had undergone surgical treatment for QTR during the study period. M63 Disorders of muscle in diseases classified elsewhere. The previous studies reporting the increasing incidence of degeneration-related tendon injuries and lesions have called for the application of preventive measures [ 817 ].

Better knee function after surgical repair of acute quadriceps tendon rupture in comparison to acute patellar tendon rupture. Sign Up Now. A family history, which almost always is present in genetic myopathies, may also be present in other causes of weakness, including lupus, rheumatoid arthritis, dermatomyositis, polymyositis, and the potassium-related paralyses 27 Table 6 57 — 1517182124 — 273436 Log in Best Value! Pan Afr Med J.

Disorder of muscle, unspecified

Incidence of QTR is largely unknown. In total, QTR surgeries were performed on patients during the study period. National Center for Biotechnology InformationU. Toggle navigation. AR wrote the draft of the manuscript and performed the statistical analyses.

The mean age of the male patients increased from Open in a separate window. On the register-based measurement of the prevalence and incidence of diabetes and its long-term complications. The average yearly increase in the number of surgeries was 9. Diagnosis Index entries containing back-references to M

Funding No funding was received for this work. No randomised clinical hypothyroidksm RCT that have compared different surgical treatment methods have been published. To the best of our knowledge, this is the first study to assess the nationwide incidence of surgically treated QTRs. In addition, recent studies suggest that the incidences of distal BTRs and RC lesions are also increasing [ 13171920 ]. Abstract Purpose Due to increased life expectancy and a more active life style of the older people, we hypothesised that the incidence of quadriceps tendon rupture QTR is higher than previously reported. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. To calculate the incidence rate of quadriceps tendon repairs, the annual adult population living in Finland was obtained from the online registry maintained by Official Statistics of Finland.

Reprints are not available from the author. Minimum rating 20 combinations of disabilities Anatomical loss of one hand and loss of use of one foot 1 Anatomical loss of one foot and loss of use of one hand 1 Anatomical loss of both hands 1 Anatomical loss of both feet 1 Anatomical loss of one hand and one foot 1 Loss of use of both hands 1 Loss of use of both feet 1 Loss of use of one hand and one foot 1 Neurol Clin. Diagnosis begins with a patient history distinguishing weakness from fatigue or asthenia, separate conditions with different etiologies that can coexist with, or be confused for, weakness. Histochemical techniques assay for specific enzymes and proteins, and may reveal deficiencies as in disorders of carbohydrate or fatty acid metabolism or the muscular dystrophies. Patellar tendon rupture showing a marked distance between the tibial tuberosity and the bottom of the patella.

Other and unspecified arthropathy

Pourmand R. Immunologic rheumatic disorders. Contact afpserv aafp. The Joint Involved in "Runner's Ttendonitis. Histology may show atrophic, degenerating, and regenerating muscle fibers general findings referred to as myopathic changesor it may show more specific findings such as accumulations of glycogen glycogen storage diseasesragged red fibers mitochondrial myopathiesnoncaseating granulomas sarcoidosisand amyloid deposits amyloidosis.

In total, QTR surgeries were performed on patients during the study period. The average yearly increase in the number of surgeries was 9. Code mechanism injuries tendoitis the knee: demographic characteristics and comorbidities from a review of patient records. The previous studies reporting the increasing incidence of degeneration-related tendon injuries and lesions have called for the application of preventive measures [ 817 ]. Funding No funding was received for this work. Diagnosis Index entries containing back-references to M In our study, the mean age of the male patients sustaining a QTR increased from

Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. The Finnish National Hospital Tendonitie Register was searched for all adult patients who had undergone surgical treatment for QTR during the study period. Int Orthop. Med Sci Sports Exerc. Because QTR is only very rarely treated without surgery, the results of our study can be considered to be a reliable estimate of the increase in the incidence of this condition.

Enthesopathies, lower limb, excluding foot

Results During the study period, QTR surgeries were performed. Please review our privacy policy. All duplicate patients were excluded from the data, and only the first instance of surgery was included.

During surgery, the tendon is reattached to the top of the kneecap bone. Curr Opin Rheumatol. Inclusion body myositis. Elevated myoglobin; positive ANA less common; myositis autoantibodies may be present. Rehab for a Patellar Tendon Rupture.

Prosthetic replacement of ankle joint: For 1 year following implantation of prosthesis With chronic residuals consisting of severe hypotnyroidism motion or weakness 40 With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to or Bannwarth B. Curr Opin Rheumatol. Note 2 : The 20 percent rating on the basis of activity within the past 5 years is not assignable following the initial infection of active osteomyelitis with no subsequent reactivation. The prerequisite for this historical rating is an established recurrent osteomyelitis. Alcohol; amyloid; glycogen storage disease; inflammatory myopathies; muscular dystrophies; sarcoid. Easy bruising; emotional lability; obesity.

  • Support Center Support Center. Distal biceps tendon ruptures: an epidemiological analysis using a large population database.

  • The brace can usually be discontinued after three months, and sports resumed in four to six months. This structure allows the knee to flex and extend, allowing use of basic functions such as walking and running.

  • Toggle navigation.

  • Physical examination. If the swelling isn't too severe, you may be able to see a divot or gap where the tear in the tendon is located.

  • Selective atrophy of type II muscle fibers. Rating Bones, of the lower extremity, shortening of: Over 4 inches

Partial quad tendon injuries can occur in association with athletic activities or active lifestyles. Strain of right quadriceps muscle, fascia and tendon. Elevated myoglobin; ANA positive; myositis autoantibodies may be present. Louis: Mosby, Code is valid for submission on a UB Expert Opin Drug Saf.

We read every comment! Curr Opin Rheumatol. Chronic fatigue syndrome. Elevated transaminase and GGT levels; anemia; decreased vitamin B Eur J Neurol. Pathologic evaluation of the muscle tissue specimen focuses on histologic, histochemical, electron microscopic, biochemical, and genetic analyses; advances in technique have made a definitive diagnosis possible for many myopathies. Note 3 : The ratings for the active process will not be combined with the residual ratings for limitation of motion, ankylosis, or diagnostic code

Arthropathy, unspecified

Use a child code to capture more detail. In daily life, it acts as part of the extensor mechanism to straighten the knee. At least 50 years younger than 50 years: rare. Treating Tendinitis of the Patella Tendon. Variable, normal, or elevated.

The previous studies reporting the increasing incidence of degeneration-related tendon injuries and lesions have called for the application of preventive measures [ 817 ]. The major etiological factors that have been suggested to explain these changes are an increase in life expectancy and a more active life style [ 13 ]. External link. Only one study reporting the incidence of QTR has been published.

Section SS Toggle navigation ICD. It's the extensor mechanism that allows us to straighten our knee or perform a kicking motion. Weight loss; tachycardia; increased perspiration; tremor.

Type 2 Excludes arthropathic psoriasis L Since this study was hypothyroodism on a national register, no sample size calculation was performed. FinDM II. The major etiological factors that have been suggested to explain these changes are an increase in life expectancy and a more active life style [ 13 ]. Compliance with ethical standards Conflict of interest None of the authors have anything to disclose.

Other specified injury of left quadriceps muscle, fascia and tendon, subsequent encounter

M13 Other arthritis. Histologic analysis of ruptured quadriceps tendons. Funding No funding was received for this work. The previous studies reporting the increasing incidence of degeneration-related tendon injuries and lesions have called for the application of preventive measures [ 817 ].

Icd deficiency. Already a member or subscriber? Polymyalgia rheumatica. Gottron papules; heliotrope rash; calcinosis; interstitial lung disease; disordered GI motility. Rare causes of muscle weakness include genetic muscular and myotonic dystrophiesmetabolic glycogenoses, lipidoses, and mitochondrial defectsand sarcoidand amyloid-associated myopathies 24 — 2634 — 38 Tables 4 5 — 813 — 26 and 5 681516182024 — Postoperative functional rehabilitation after repair of quadriceps tendon ruptures: a comparison of two different protocols. Human immunodeficiency virus HIV is a less common cause of muscle weakness but should be considered in patients with associated risk factors or symptoms.

The force of muscle contraction is transmitted through the tendon to move the bone. Patellar tendon rupture showing a marked distance between the tibial tuberosity and the bottom of the patella. Note 3 : In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note 2. Pulmonary testing may reveal the crackles of a restrictive lung defect, found in some inflammatory and rheumatologic myopathies. The Shoulder and Arm. Muscle biopsy abnormalities in systemic lupus erythematosus: correlation with clinical and laboratory parameters. To code a diagnosis of this type, you must use one of the three child codes of S

The incidence of QTR is higher than previously reported, and it has increased steeply in recent years. This article has been cited by other articles in PMC. Med Sci Sports Exerc. Incidence of QTR is largely unknown. The following code s above M Contrary to other tendon ruptures that affect older patients, non-operative treatment is very seldom reasonable option for QTR [ 5 ].

Myopathy, unspecified

Only one study reporting the incidence of QTR has been published. Published online Mar Learn More.

  • Try out PMC Labs and tell us what you think. The majority of the observed three-to-fivefold increase in incidence is, therefore, likely due to other factors.

  • Variable, normal, or elevated.

  • The annual incidence of quadriceps tendon repairs perpersons was calculated. The following code s above M

  • Arthralgia; malaise; myalgia; respiratory symptoms. The pattern is important.

Hypothyroisism, especially forearm and hand. Reprints are not available from the author. Partial tears of the quadriceps tendon can usually be managed with non-surgical treatments, quadriceps tendonitis icd 10 code for hypothyroidism may include the use of:. If the neurologic examination is unrevealing, a more general physical examination, searching for extramuscular signs, is warranted Table 6 57 — 1517182124 — 273436 An eccentric contraction can occur with injuries such as a slip on wet ground or a sports injury.

National Center for Biotechnology InformationU. Clinical outcomes after repair of quadriceps tendon rupture: a systematic hypthyroidism. Disorders of muscles Type 1 Excludes dermatopolymyositis M This article has been cited by other articles in PMC. Of these, Discussion The most important finding of the present study was the steep increase in the annual incidence of operatively treated QTRs from to

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