Presentation
History of jerk / indirect injury to the anterior aspect of both thighs while cricket bowling about a week back. The right thigh was injured first followed by the left thigh. Complaining of bilateral anterior proximal - mid third of thigh pain.
Patient Data
RIGHT Rectus femoris
- Direct head tendon - intact
- Indirect head tendon - intact
- Superficial aponeurosis - intact
- Central aponeurosis - intact
- Distal aponeurosis - intact
- There is an area of loss of normal muscle echo pattern involving outer muscle( direct head ). It Involves proximal mid third of thigh, away from the central aponeurosis. There are fluid clefts within it without encapsulated collection. It measures about 50 x 25 x 15 mm.
- Other anterior muscles are normal.
- There is no subcutaneous collection.
LEFT Rectus femoris
- Direct head tendon - intact
- Indirect head tendon - intact
- Superficial aponeurosis - intact
- Central aponeurosis - intact
- Distal aponeurosis - intact
- There is an area of loss of normal muscle echo pattern involving outer muscle( direct head ). It involves proximal mid third of thigh, away from the central aponeurosis. There are fluid clefts within it without encapsulated collection. It measures about 55 x 25 x 15 mm.
- Other anterior muscles are normal.
- There is no subcutaneous collection.
Case Discussion
The rectus femoris muscle is one of the quadriceps muscles. It has muscle within the muscle structure. The outer muscle originates from superficial aponeurosis which forms direct tendon. The inner muscle originates from central aponeurosis which forms indirect tendon. The superficial aponeurosis is aligned in the coronal plane. The central aponeurosis is a sagittally oriented band. Both muscle fibers insert into deep aponeurosis in the distal thigh. Rectus femoral is one of the few muscles crossing two joints ( hip and knee joint in this case ). It is prone to injury in sports due to eccentric forces.
Ultrasound findings show grade I muscle injury involving the outer muscle of bilateral rectus femoris in a cricket player.
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