Rectus Femoris Muscle Injury

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Rectus Femoris Muscle Injury

Authors, Editors, Case Information Author: Jessica Buttinger, MD, MS Affiliation: Mayo Clinic, Department of Physical Medicine and Rehabilitation. University of Iowa, Division of Sports Medicine. Co Author(s): Ben Kopecky, DO, Mederic Hall, MD. Senior Editor: Laura Mattson, DO Clinical Vignette: A 21-year-old female Division I collegiate soccer player presented with a one-week history of insidious-onset sharp pain in the left anterior thigh, localized to the distal aspect of the proximal third of the thigh. Symptoms were exacerbated by sprinting and refractory to conservative therapies, including dry needling, Graston technique, and electrical stimulation. Pain was alleviated with rest and ball work (passing and shooting). Type of Probe Used: 14 MHz High frequency Linear Transducer (14L5) Unalebeld Short Axis View of the Rectus Femoris Muscle Unlabeled Short Axis View of the Rectus Femoris Muscle Unlabeled Short Axis View of the Rectus Femoris Muscle with Doppler Unlabeled Short Axis View of the Rectus Femoris Muscle with Doppler. Unlabeled Long Axis View of the Rectus Femoris Muscle Unlabeled Long Axis View of the Rectus Femoris Muscle. Labeled Short Axis View of the Rectus Femoris Muscle Labeled Short Axis View of the Rectus Femoris Muscle with an anechoic fluid collection within the muscle consistent with intramuscular hematoma measuring approximately 1.93 cm x 0.51 cm. Muscle edema (arrows) appreciated at the site of injury surrounding the hematoma. Labeled Short Axis View of the Rectus Femoris Muscle with Doppler Labeled Short Axis View of the Rectus Femoris Muscle with Doppler. Hematoma within the rectus femoris with increased Doppler signal in the surrounding muscle. Labeled Long Axis View of the Rectus Femoris Muscle Labeled Long Axis View of the Rectus Femoris Muscle with an anechoic hematoma within the rectus femoris muscle measuring approximately 4.74 cm in length. Interpretation Image Interpretation: The direct and indirect head of the rectus femoris tendons are intact proximally. The central intramuscular tendon of the rectus femoris is intact and normal in appearance. There is an acute muscle injury at the peripheral aspect of the rectus femoris near the junction of the proximal and middle third of the thigh. The injury is at the deep lateral aspect of the muscles and measures approximately 1.93 x 0.51 x 4.75 cm. There is an ancechoic compressible hematoma present. The injury does not extend to the peripheral fascia or into the central muscle/tendon. Mild surrounding hyperemia noted on doppler imaging. Imaging consistent with an acute left rectus femoris muscle injury, British athletics muscle injury classification grade 2b. Teaching Pearl: Ultrasound provides high-resolution, real-time evaluation of muscle injury by showing the architecture of the injured muscle and associated soft tissue changes. Key findings include disrupted muscle fibers, edema, hematoma, and, during the healing phase, possible Doppler hyperemia; scanning in both long and short axis helps define injury location, size, and relationship to the myotendinous or intramuscular tendon. References: 1. Draghi F, Zacchino M, Canepari M, Nucci P, Alessandrino F. Muscle injuries: ultrasound evaluation in the acute phase. J Ultrasound. 2013;16(4):209-214. doi:10.1007/s40477-013-0019-8 2. Pollock N, James SL, Lee JC, Chakraverty R. British athletics muscle injury classification: a new grading system. Br J Sports Med. 2014;48(18):1347-1351. doi:10.1136/bjsports-2013-093302
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Authors, Editors, Case Information

Unalebeld Short Axis View of the Rectus Femoris Muscle

Unlabeled Short Axis View of the Rectus Femoris Muscle with Doppler

Unlabeled Long Axis View of the Rectus Femoris Muscle

Labeled Short Axis View of the Rectus Femoris Muscle

Labeled Short Axis View of the Rectus Femoris Muscle with Doppler

Labeled Long Axis View of the Rectus Femoris Muscle

Interpretation

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