Age / Sex : 13 / M

Chief complaint :

 Rt. Thigh pain, due to trauma


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 김선기 (Sun Ki Kim), 가톨릭대학교 인천성모병원 (Incheon St. Mary’s Hospital, The Catholic University of Korea)

Intramuscular Degloving Injury of the Rectus Femoris

Discussion

Findings:

MRI  :

1. Rupture in the indirect (central) tendon of rectus femoris muscle, with surrounding fluid.


2. Proximal retraction in the indirect head of the rectus femoris muscle.

Differential Diagnosis:

Sof tissue tumor, inflammation, ganglion

Discussion:

Rectus femoris muscle - consists of two heads.

1) direct (straight) head  (arise from anterior inferior iliac spine of the ilium)

--> unipennate muscle and blends with the anterior fascia.

2) indirect (reflected) head  (arise from superior acetabular ridge and hip capsule)

--> the deep, central intramuscular tendon (bipennate muscle), which is enveloped by unipennate muscle.

( outer unipennate muscle surrounds an inner bipennate muscle à muscle-within-muscle configuration )

• Intramuscular degloving injury of the rectus femoris –

separation of the central indirect tendon (inner bipennate component) from the outer (surrounding unipennate component) rectus femoris muscle à this appearance is similar with a finger in a glove à therefore, it is called intramuscular degloving injury

  References:

 1. Kassarjian A, Rodrigo RM, Santisteban JM. Intramuscular degloving injuries to the rectus femoris: findings at MRI. AJR Am J Roentgenol 2014;202(5):W475–W480.

 2. Mariluisa CA, Cupitob J, Mamone F. Muscle injuries of the rectus femoris muscle. MR update. Rev Argent Radiol. 2015;79(4):182–91.

 3. Gyftopoulos S. Rosenberg ZS, Schweitzer ME, Bordalo-Rodrigues M. Normal anatomy and strains of the deep musculotendinous junction of the proximal rectus femoris: MRI features. AJR 2008; 190:[web]W182–W186