Distal Thigh Popping And Pain In A Former Collegiate Sprinter - Page #1

Author: Kristin Garlanger, DO
Co Author #1: Adam M. Pourcho, DO
Co Author #2: Kentaro Onishi, DO
Co Author #3: Jacob L. Sellon, MD
Editor: Todd May, DO

Patient Presentation:
A 31-year old former collegiate sprinter presented to sports medicine clinic with right posteromedial distal thigh/knee pain.

This occurred suddenly three months prior as he was taking off from home plate during a kickball game. He noticed initial ecchymosis and swelling with a sense of weakness in knee flexion. He subsequently had several painful “popping” episodes during a back/hip extension exercise. No neurologic symptoms. Past history included multiple mid-hamstring strains during his competitive sprinting days, which were less functionally limiting than his presenting symptoms. Since the acute episode, he had been unable to return to full sprinting activities secondary to pain. He attempted a self-directed stretching and strengthening program with limited success.

Physical Exam:
This was a muscular, fit-appearing young male in no acute distress. He had faint ecchymosis in the posteromedial distal thigh and knee. Knee flexion strength was intact and symmetric on manual muscle testing. His gait was non-antalgic. Lower limb range of motion was full and pain-free. The popliteal angles were 35 degrees on the right and 40 degrees on the left. There was a palpable defect and tenderness to palpation at the distal semitendinosus musculotendinous junction. Pain was provoked with resisted knee flexion and single leg standing back/hip extension. Popping was not reproducible during the examination. There was no knee effusion. Cruciate/collateral ligaments were stable.

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