Disclosures: Sudeep K. Mehta, MD: Nothing to disclose

Case Description: A 47-year-old veteran presented with acute left hip pain after a tackle during a sporting event. Magnetic resonance imaging (MRI) demonstrated a full thickness tear at the proximal insertion of the rectus femoris muscle. The patient underwent conservative management, rehabilitation, and cryotherapy with subsequent resolution of symptoms.

Setting: Outpatient Musculoskeletal Clinic

Patient: The patient presented with a hyperextended and internally rotated left hip. He experienced moderate to severe pain in his left hip after his injury, limiting his daily activities. Physical exam did not demonstrate abnormalities in lower extremity strength, reflexes and sensation.

Assessment/Results: MRI of the hip demonstrated a full-thickness tear at the proximal insertion of the rectus femoris muscle with surrounding inflammatory changes. He was prescribed ibuprofen, analgesic balm and physical therapy. He attended physical therapy sessions to strengthen his quadriceps, and further received cryotherapy. One month later, he reported complete resolution of symptoms.

Discussion: Proximal rectus femoris tendon tears are uncommon and seen in high-level athletes after extrinsic force such as kicking a ball. Symptoms include sudden, sharp pain in the groin and anterior hip. Treatment usually requires surgical intervention. This is a case of a healthy middle-aged man with acute left hip pain after sustaining direct trauma. A proximal rectus femoris tendon tear was observed on MRI after an unusual mechanism of injury. Conservative treatment sufficed in resolving his symptoms, highlighting the possibility of avoiding surgery.

Conclusion: It is imperative to rule out a rectus femoris injury after acute hip trauma. Strengthening proximal hip flexors and knee extensors may lead to a reduction in rectus femoris injuries. Weight training may assist in strengthening the quadriceps, and electrostimulation may increase isometric strength of the quadricep femoris muscles. An effective rehabilitation program may further eliminate the need for surgery if functional restoration is achieved with resolution of symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atypical-presentation-of-a-proximal-rectus-femoris-rupture-a-case-report/