Right Thigh Mass in a Division 1 Baseball Player

Abstract

HISTORY: 18y WM baseball outfielder with 4 year history of "golf ball" sized proximal quadriceps hernia presented to student health services with complaint of increase in hernia size and pain. The hernia had previously been treated non-operatively without incident. 2 weeks prior to evaluation, he was in the gym doing a deep squat and had an episode of increased size and pain of his hernia. He continued to have pain over the next two weeks despite therapy in the training room. He was brought to health services by the athletic trainer for further evaluation and recommendations. PHYSICAL EXAM: VS T:97.5F, BP 102/70, Wt 152 Lbs Spontaneously reducible 8-10 cm herniation of proximal third of the anterior aspect of the quadriceps muscle starting approximately 6 cm distal to the anterior inferior iliac spine and extending distally. Mild tenderness to palpation of muscle belly. No cutaneous or skin changes or breakdown. Quadriceps strength 5/5. Sensation is intact. DIFFERENTIAL DIAGNOSIS: Extension of muscle hernia Femoral hernia Neoplasia TESTS/RESULTS: -Initial evaluation of his hernia 4 years ago included MRI which reportedly showed a defect of the fascia overlying the quadriceps -Attempting to acquire previous MRI and will repeat MRI if symptoms worsen Final/Working Diagnosis: Extension of rectus femoris muscle hernia TREATMENT/OUTCOMES: Ice, NSAIDs, rest Evaluation by orthopedist to discuss surgical repair of anterior thigh fascia Activity modification to avoid squats, leg press and similar activities Gradual progression to sport-specific play Final outcome pending