Working Diagnosis:
Right quadriceps bipennate rectus femoris tear with degloving

Treatment:
Patient was placed in physical therapy with a focus on quadriceps strengthening and hip range of motion. A 10 day course of Ibuprofen was prescribed to treat the inflammation and assist in preventing myositis ossificans. Aspiration of the right thigh was performed for pain relief 10 days after initial presentation as this was the earliest patient could return.

Outcome:
Patient return-to-play was immediate as he had full range of motion and no strength deficits despite his injury. While playing he was able to tolerate any discomfort and perform at his full capacity. He continued with physical therapy during this time.

Author's Comments:
A degloving injury of the rectus femoris (RF) is a rare injury occurring due to the unique anatomy of this quadriceps muscle. The RF is bi-articular and composed of the distal merging of two proximal heads: a direct unipennate originating from the AIIS and an indirect bipennate originating from the superior acetabular ridge. Case Photo #5 RF degloving is classified as intramuscular bipennate fibers separating from surrounding unipennate fibers. Case Photo #6 Function of the RF is to assist with hip flexion and knee extension.
A video presentation of this case is available at https://vimeo.com/408127998

Editor's Comments:
Baseball agility drills such as the Z drill involving repetitive hip and leg extension motions are the perceived mechanism of injury in this patient. Because of its rarity there is scare documentation of a RF injury on Ultrasound and MRI in the same patient.

References:
1. Kassarjian, A., Rodrigo, R.M., & Santisteban, J.M. (2014). Intramuscular degloving injuries to the rectus femoris: findings at MRI. AJR. American journal of roentgenology, 202 5, W475-80.

2. Morgan, C., Konopinski, M., Dunn, A., & Milsom, J. (2018). Rehabilitation of Rectus Femoris Injuries in Kicking Athletes Rehabilitation of Rectus Femoris Injuries in Kicking Athletes.

3.Kary JM. Diagnosis and management of quadriceps strains and contusions. Curr Rev Musculoskelet Med. 2010;3(1-4):26-31. Published 2010 Jul 30. doi:10.1007/s12178-010-9064-5

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