| Introduction |
 Due to overstretching the muscle which results in tearing of the muscle fibers of the rectus femoris- Epidemiology
- seen more commonly in soccer and football players
- Mechanism of injury
- sudden, forceful eccentric contraction of the muscle
- sprinting from standing position
- kicking soccer ball with great force
- Pathophysiology
- acute injuries
- usually more distal on the thigh
- chronic injuries
- usually occur closer to the muscle origin
- Associated conditions
- avulsion of anterior inferior iliac spine (AIIS)
- adolescent athletes may have proximal bony avulsion of anterior inferior iliac spine (AIIS)
- occurs at insertion site of superior head of rectus femoris
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| Anatomy |
- Osteology
- anterior inferior iliac spine (AIIS)
- origin of direct head of rectus femoris muscle
- Muscles
- rectus femoris
- crosses hip and knee joint
- flexes hip and extends knee
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| Presentation |
- Symptoms
- pain in the anterior aspect of the hip
- strain or avulsion at insertion on AIIS
- pain midthigh
- pain distally
- Physical exam
- inspection and palpation
- tenderness to palpation in the injured area
- proximally at origin of rectus femoris muscle
- muscle belly midthigh region
- distally at knee
- feel for defect in muscle indicating a full tear (unusual finding)
- provocative maneuvers
- pain elicited with resisted hip flexion or extension
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| Imaging |
- Radiographs
- indications
- concern for avulsion at insertion site on anterior inferior iliac spine in adolescent athletes
- findings
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| Treatment |
- Nonoperative
- NSAIDS, rest, ice, stretching/strengthening
- indications
- definitive treatment for vast majority
- outcomes
- usually resolves within 4-6 weeks
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Please Rate Educational Value!
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4.0
t-3104
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Average 4.0 of 5 Ratings
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Qbank (1 Questions)
TAG
(OBQ08.151)
A teenage boy injured his hip while competing in a track meet. His radiograph is shown in Figure A. Which of the following muscles is most likely injured?
Review Topic
DISCUSSION:
Adolescent athletes may sustain an avulsion of the anterior inferior iliac spine (AIIS) which is due to the pull of the rectus femoris. Figure A shows a radio-density overlying the right acetabulum which is consistent with a mildly displaced AIIS avulsion in a skeletally immature patient.
The rectus femoris originates at the AIIS and inserts into the patellar tendon as one of the four quadriceps muscles (see illustration A).
Illustration B details the sites for different muscle avulsion injuries around the pelvis which are commonly seen in adolescent athletes.
Illustrations:
A
B
REFERENCES:
1.
Hollingshead WH: Anatomy for Surgeons ed. 3,pp 987-1038.
2.
Anderson JE: Grant’s atlas of Anatomy ed. 7, Figure 4-42.
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Please Rate Educational Value!
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3.0
q-537
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Average 3.0 of 8 Ratings
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Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
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Anderson JE: Grant’s atlas of Anatomy ed. 7, Figure 4-42.
Textbooks
- Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
- AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
- Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
- Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
- Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
- Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
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Hollingshead WH: Anatomy for Surgeons ed. 3,pp 987-1038.
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