Wk 3, Case 4 - Review

Patient History: 25-yo male hockey player with right hip pain
Findings
SKELETAL: No bone contusion or fracture. No avulsion fracture. No infiltrative or destructive bone lesion.

PELVIS: No free fluid in the pelvis. No hernia. Normal urinary bladder. Symmetric piriformis muscles.

JOINTS: Short femoral neck and decreased femoral-head neck junction offset. Impingement-related pitting and pseudocyst formation within the right femoral-head neck junction. No AVN or loose body. No effusion. Intact ligamentum teres. Symphysis pubis arthrosis and right osteitis pubis.

ACETABULUM/LABRUM: Lateral right acetabular labral fraying and high-grade partial tear anteriorly and laterally.

MUSCLES/TENDONS/LIGAMENTS: Normal gluteus medius and minimus insertions. Normal right and left hamstring origins.

Right rectus femoris rupture, complete, with distal distraction by 4cm. Both direct AIIS and indirect anterolateral acetabular roof components are avulsed. No avulsion fracture fragment or fracture of the anterior inferior iliac spine. Moderate surrounding soft tissue swelling. No drainable hematoma.

OTHER/SOFT TISSUE: The remaining musculature is normal. No hernia. The vasculature is normal.

Conclusion
1. Rectus femoris avulsion/rupture, includes both the direct and indirect heads, from the anterior inferior iliac spine, without avulsion fracture fragment, 4 cm retracted. Moderate surrounding soft tissue swelling but no drainable hematoma.
2. Additional muscle strains about the right hip, without additional rupture. No muscle atrophy.
3. Decreased femoral head neck junction offset and cam-type femoroacetabular impingement. Right lateral and anterior acetabular labral fraying versus partial-thickness tearing.