Author: Ryan Robin, MD
Co Author #1: Edward Laskowski, MD

Patient Presentation:
15-year-old female soccer and track athlete presented with right anterior thigh pain. Initial injury occurred three years prior during soccer season with acute onset of right quadriceps pain after a kick. She continued to experience focal, non-radiating pain in the region of the mid anterior thigh over the course of the next three years when performing explosive activities such as jumping and running. There were no neurologic symptoms. She remained active and continued sports and lower extremity strength training. Three weeks prior to presentation, she experienced an exacerbation of her symptoms when running. Her athletic trainer noted a palpable anterior thigh mass that did not resolve with stretching, heat, or massage.

History:
No significant past medical or surgical history.

Physical Exam:
Skin: Skin inspection grossly negative in affected area.
Lymph: No lymphadenopathy in the involved limb.
Joint ROM: Joint range of motion is full and pain-free in the affected extremities. No gross appendicular deformities.
Palpation: Inspection and palpation of the spine and extremities are unremarkable except for tenderness to palpation of the mid right
rectus femoris where there appears to be a movable cyst-like subcutaneous mass 30cm proximal to the superior pole of the patella. This was accentuated when she contracts the quadriceps muscle. There does not appear to be any discontinuity of the
rectus femoris
Provocative Tests:
Hip: Negative FABER and Stinchfield's tests.
Knee: No knee effusions. Negative Lachman's, posterior drawer, and McMurray's tests. No pain or laxity on stressing of medial and
lateral collateral ligaments. Negative patellar apprehension and normal patellar glide; no patellar facet or patellar tendon tenderness.
Gait: Gait reveals normal cadence and stride.
Strength: All major muscle groups of the bilateral lower extremities have normal and symmetric muscle strength, bulk, and tone.
Sensation: Grossly intact to light touch throughout both lower extremities.

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