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Updated: Jun 1 2021

Rectus Femoris Strain

  • summary
    • A rectus femoris strain is a traumatic injury caused by overstretching of the muscle which results in tearing of the muscle fibers of the rectus femoris.
    • Diagnosis is made clinically with tenderness over the rectus femoris made worse with resisted hip flexion or extension.
    • Treatment is conservative with NSAIDs, rest and stretching. 
  • Epidemiology
    • Demographics
      • seen more commonly in soccer and football players
  • Etiology
    • Pathophysiology
      • mechanism
        • sudden, forceful eccentric contraction of the muscle
          • sprinting from standing position
          • kicking soccer ball with great force
      • pathoanatomy
        • 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 direct head of rectus femoris
  • 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
  • Presentation
    • Symptoms
      • pain in the anterior aspect of the hip
        • strain or avulsion at insertion on AIIS
      • pain midthigh
        • strain in muscle fibers
      • pain distally
        • most common finding
    • 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
  • Imaging
    • MRI
    • Ultrasound
    • Radiographs
      • indications
        • concern for avulsion at insertion site on anterior inferior iliac spine in adolescent athletes
      • findings
        • normal in most cases
  • Treatment
    • Nonoperative
      • NSAIDS, rest, ice, stretching/strengthening
        • indications
          • definitive treatment for vast majority
        • outcomes
          • usually resolves within 4-6 weeks
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