Anterior Thigh Pain in a Collegiate Basketball Player

Abstract

HISTORY: A 21 year old college student was playing basketball when he sustained an injury to his right thigh. He jumped up for a rebound and when he landed, he felt a pop and experienced pain over his right anterior thigh. He was unable to continue playing. He developed ecchymosis over the injured site. The pain was gradually improving when he sought medical attention four weeks later. He had not yet returned to playing basketball. He denied any numbness, tingling, or paresthesias. He denied low back pain or knee pain. By the time of his follow-up examination five weeks later, he had resumed playing basketball. He denied any further pain, however he occasionally experienced weakness and instability of his right knee. PHYSICAL EXAM: On initial examination, he was ambulating with a normal gait. He had no gross deformity or atrophy, no palpable tenderness or defect over his quadriceps muscle, and no appreciable soft tissue swelling or ecchymosis. He had no pain to active quadriceps resistance. Knee and hip range of motion were normal with no pain to resistive testing. Distal neurovascular exam was intact. On follow-up examination he had a grossly visible and palpable deformity over the anterior proximal thigh with tightening of quadriceps/VMO. The deformity was soft, non-tender and mobile. DIFFERENTIAL DIAGNOSIS: Quadriceps strain/rupture Hematoma Sarcoma Myositis Deep venous thrombosis TEST AND RESULTS: MRI right thigh: Myofascial muscular strain involving the rcctus femoris with suspicion for a tear of the tendon. A fluid component was seen around the inferior portion of the muscle extending down along the course of the expected tendon. MRI right knee: Small joint effusion. Extensor mechanism at level of the knee was intact. Equivocal findings for sprain of anterior cruciate ligament. FINAL WORKING DIAGNOSIS: Rectus femoris tendon tear TREATMENT AND OUTCOMES: Non-operative management with supervised physical therapy. Returned to playing basketball less than 4 weeks post injury.