Common extensor tendon rupture following a corticosteroid injection and olympic weightlifting: A case report, management, and outcome

Introduction: Corticosteroid injections are a common form of treatment for orthopedic-related pain, such as knee arthritis, shoulder arthropathy, and in this case, lateral epicondylitis. While most cases of elbow epicondylitis are self-limited and resolve over a 12- to 18-month period, patients often seek treatment for more immediate pain relief well before then. Any form of treatment comes with its own risks, benefits, and alternatives, and corticosteroid injections are no different. Many patients suffering from chronic pain and pain-limited ability to do their activities of daily living or other activities they enjoy choose corticosteroid injections, reasoning that the benefits grossly outweigh the risks. When administered correctly, most patients tolerate corticosteroid injections without complications, and the reported complication rate is very low. Complications from corticosteroid injections are rare but include post-injection pain, tendon rupture, benign skin changes, subcutaneous tissue atrophy, and infection—the most common complications are limited to pain and skin changes. Previous publications report the possible complication of tendon rupture of the flexor digital, patellar, and Achilles tendons associated with corticosteroid injections. Still, few reports of such injuries require a high degree of intervention, such as tendon reconstruction and a muscle flap. Case Report: This case report discusses the rare presentation of skin changes, fat atrophy, lateral collateral ligament (LCL) rupture, and retraction of the right elbow common extensor origin after a single corticosteroid injection and acute weightlifting injury, requiring lateral ulnar collateral ligament reconstruction and an anconeus rotational muscle flap. Conclusion: Complete rupture of the common extensor tendon, in addition to massive soft tissue atrophy causing capsular instability, is rare. In the present case, the administration of a corticosteroid injection placed the tendon and surrounding soft tissue at risk, coupled with excessive axial force and varus stress from weightlifting, caused this injury. Care must be taken when correctly placing corticosteroid injections to avoid subcutaneous lipoatrophy and intratendinous placement.