Rectus Degloving Injury From Kickball

HISTORY: 38-year-old active male with no major past medical history presented with one-week of acute right anterior mid-thigh pain and palpable lump after playing kickball. PHYSICAL EXAMINATION: Tenderness noted at ASIS/AIIS along with a well-circumscribed mobile mass along mid anterior thigh. Popping palpated at the anterior hip going from flexion/external rotation to extension/internal rotation were also noted. DIFFERENTIAL DIAGNOSIS: 1.Strain of rectus femoris muscle 2.Rectus femoris tear 3.Snapping hip syndrome4.ASIS/AIIS avulsion fracture TESTS AND RESULTS: Right thigh MRI without contrast:-intramuscular degloving injury of the rectus femoris muscle -edema within the inner and outer muscular portions of the rectus femoris within the tear region-20 mm retraction of the torn inner indirect myotendinous complex of the rectus femoris FINAL/WORKING DIAGNOSIS: Intramuscular degloving injury of the rectus femoris. TREATMENT AND OUTCOMES: 1.Advised to avoid aggressive quadriceps contractions, high intensity and high impact exercise 2.After consultation with orthopedics, patient did not require surgery or other intervention.3.Rehabilitation with 6-to-8 weeks of physical therapy with improvement in range of motion and strength, improved tolerance with physical activity and exercise. The rectus femoris muscle is characterized by a unique muscle-within-a-muscle structure, where the inner bipennate muscle is encircled by an outer unipennate muscle. The unique anatomy of rectus femoris and the fact it crosses two joints makes it susceptible to different injuries. Kicking sports may increase risk, although kickball may be unique due to the elastic loading from increased deformation of the kickball compared to other ball sports resulting in stronger opposing muscle forces within this unique anatomy. However, intramuscular degloving injuries aren’t currently included among the various muscle injury classifications. Given the high prevalence of rectus femoris muscle injuries in sports and the unique anatomy of the rectus femoris, providers should be aware of the rare intramuscular degloving injury. A thorough workup is recommended to assess for intramuscular degloving injury and to improve patient prognosis and rehabilitation.