Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Rupture of the Rectus Femoris Muscle

SYMPTOMS

There is an acute onset of sharp tearing pain in the proximal anterior thigh or towards the anterior iliac crest during activity. This injury often occurs during intense activity in sports like tennis, squash or other sprinting and jumping sports.

AETIOLOGY

This is usually a partial rupture of the insertion or proximal muscle bulk of the rectus femoris after excessive hip extension or eccentric contraction from push-off or landing.

CLINICAL FINDINGS

There is tenderness on palpation over a localised area of the insertion of the muscle bulk. Resistance testing of the muscle in question will cause further pain. Jumping and landing on the forefoot with a straight knee is painful and hip flexion with straight knee against resistance and startingfrom maximal hip extension is very painful.

INVESTIGATIONS

This diagnosis is made from the patient’s history and clinical findings. Ultrasound or MRI can demonstrate the rupture and haematoma. These investigations are important if the initial diagnosis has been missed and can grade the rupture, which is important for rehabilitation and length of absence from sport.

TREATMENT

In the acute situation, RICE. This injury most often responds to conservative treatment including modification of training and strength exercises over three months, which is the usual healing time. Partial weight bearing is usually allowed earlier.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for planning of a three to six months’ return programme back to sport.

EXERCISE PRESCRIPTION

Cycling, water exercises and other low-impact activities are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Strength and flexibility must be monitored objectively to be complete at the end of rehabilitation when compared with the other leg. The risk is otherwise high that the weaker muscle will re-rupture.

DIFFERENTIAL DIAGNOSES

This is usually a straightforward diagnosis but still often missed.

LONG-TERM PROGNOSIS

Excellent but re-ruptures are common due to a too-early return to sport and insufficient rehabilitation.

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