Rectus Femoris Rupture

 RECTUS FEMORIS RUPTURE

 

 

INTRODUCTION:

The rectus femoris muscle is one of quadriceps muscles. It goes from the hip to the knee and can be used to straighten the knee or lift the knee up. This muscle can rupture or become inflamed at the upper part. The main cause of this is overuse through kicking or explosive movements as in sprint starts.

CAUSES:

  • Overuse through kicking
  • explosive movements as in sprint starts.
  • Practitioners of sports involving a lot of explosive leg techniques:
    Martial artists, TKD, dancers, trickers etc.
  • People who don’t warm up enough or work out in a cold environment.
  • Athletes with bad flexibility or weak leg muscles.
  • Every wushu athlete who just started learning the jumps.
    Especially flying front kicks, cartwheels without hands and whirlwind kicks can lead to rectus femoris tendon ruptures.

 

SYMPTOMS:

  • A sudden sharp pain at the front of the hip / in the groin usually whilst doing some explosive activity
  • Swelling and bruising may occur.
  • Pain in lifting the knee up against resistance
  • Pain when pressing in at the point of injury
  • If it is a total rupture then it will be impossible to contract the muscle.

DIAGNOSIS:

Lab Studies

Blood studies are not generally indicated when the patient’s history is that of overuse or sudden trauma. However, if the history and physical examination findings are suggestive of renal disease, hyperparathyroidism, soft tissue tumor, or diabetes mellitus, the appropriate studies should be sent.

The following are indicated for severe contusions and ill-appearing patients:

  • Creatine kinase
  • Hematocrit
  • Coagulation studies – If patient develops spontaneous edema or is taking anticoagulants

Imaging Studies

 Initially, imaging studies may not be indicated in patients with partial rectus tears, minimally symptomatic quadriceps contusions, and mild quadriceps tendinitis. These patients have a history of acute or repetitive trauma, and the history and physical examination findings are consistent with these working diagnoses. For patients in whom the history and physical examination findings are not consistent, for patients with night pain, patients with suspected complete quadriceps rupture, those with significant quadriceps contusion, and in patients where fracture (femur or patellar), metabolic disease, or tumor is suspected, radiography is indicated on the first visit.

For patients with mild tendinitis, mild contusions, and partial rectus tears who do not respond to activity modification, rest, and physical therapy, radiography is indicated on follow-up examination.

In patients with quadriceps contusion, plain radiography may show evidence of myositis ossificans at the site of the contusion several weeks to months after injury.

Patients who have quadriceps tendinitis or partial tears of the rectus tendon may have the radiographic findings of the so-called saw tooth patella along the proximal border of the patella.

Patients with complete rupture of the tendon may have an associated patellar fracture, particularly if the patient fell on the flexed knee at the time of the injury. The radiographs in patients with complete rupture show obliteration of the quadriceps tendon shadow, patella baja, and a large effusion. A suprapatellar mass (the retracted quadriceps muscle) or a suprapatellar calcific density may also be present.

If quadriceps tendon rupture is diagnosed clinically, anteroposterior (AP) and lateral views of the knee are the minimum views required. The lateral view shows a low-riding patella, patella baja, due to the unopposed pull of the patellar tendon.

CT scanning is not usually as helpful as MRI.

Ultrasonography is less expensive than the MRI and has a high sensitivity and specificity for complete tears. Its accuracy and predictive value in partial tears is not as good.

MRI has the highest sensitivity and specificity for disorders of the quadriceps. It shows both complete and partial ruptures, soft tissue hematomas, tendinopathies, soft tissue tumors, myositis ossificans, and fascial defects. Incomplete intrasubstance tears of the rectus femoris and complete tears of the rectus femoris and quadriceps tendon are visible as increased signal intensity on the T2 images. Incomplete intrasubstance ruptures of the rectus tendon and the quadriceps tendon image as focal disruptions of the normal laminated appearance of the tendon.

Other Tests

Compartment pressure measurements should be taken if compartment syndrome is suspected in the anterior thigh.

TREATMENT:

  • Rest is the most important part. If you don’t rest enough, a partial rupture can
    lead to a total rupture. Apply Ice to reduce pain and inflammation,
    Compress and Elevate. ( well… the elevation part is a bit complicated here )
    Anti-inflammants like diclofenac may be prescribed to reduce inflammation.
  • It is very imprtant to use sports massage techniques after the acute phase.
    You can massage the rectus femoris muscle with one hand before and after training sessions.
  • Full rehabilitation program: Strengthen, stretch and massage. Consult your doctor for more info.
  • Ultrasound or Laser treatments.
  • In the worst case operation will be necessary ( if the muscle has torn completely )
    After an operation you will not be able to train properly for at leat 6 month.

PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Pain relief
  • Reduce stiffness
  • Strengthening of muscle
  • Regain full range of motion
  • Gait training
  • Advice for braces
  • Sports specific training

Visit Physioline for the Consultation and treatment