Enthesitis of the direct tendon of the rectus femoris muscle in a professional volleyball player: A case report

Abstract

Enthesitis of the direct tendon of the rectus femoris muscle is a rare pathology which mainly affects professional athletes, and it is caused by overuse and repetitive microtrauma. Athletic jumping and kicking exert a great stress on the direct tendon of the rectus femoris muscle, and volleyball and football players are therefore most frequently affected. Enthesitis may occur suddenly causing pain and functional impairment possibly associated with partial or complete tendon injuries, or it may be a chronic condition causing non-specific clinical symptoms. We present the case of a professional volleyball player who felt a sudden pain in the left side of the groin area during a training session although she had suffered no accidental injury. The pain was associated with impaired ipsilateral limb function. Tendon rupture was suspected, and magnetic resonance imaging (MRI) was performed. MRI showed a lesion at the myotendinous junction associated with marked inhomogeneity of the direct tendon. Ultrasound (US) examination confirmed the presence of both lesions and allowed a more detailed study of the pathology. This is a typical case of enthesitis which confirms that MRI should be considered the examination of choice in hip pain, particularly when the patient is a professional athlete, thanks to its panoramic visualization. However, also US is an ideal imaging technique for evaluating tendon injuries thanks to its high spatial resolution, and it can therefore be used effectively as a second line of investigation.Sommario Le entesiti del tendine diretto del muscolo retto femorale sono rare e pressoché esclusive degli atleti professionisti, legate a sovraccarico funzionale e microtraumi ripetuti. Il gesto atletico del salto e del calcio sono quelli che maggiormente sollecitano il tendine diretto del retto femorale e quindi calciatori e pallavolisti rappresentano gli atleti più frequentemente colpiti. Le entesiti possono presentarsi in maniera acuta, con dolore e impotenza funzionale, eventualmente associati a lesioni parziali o complete del tendine, o cronica con quadri clinici più sfumati. Presentiamo il caso di una pallavolista professionista che, nel corso di un allenamento (in assenza di traumi), manifestava una sintomatologia dolorosa inguinale sinistra e impotenza funzionale dell'arto omolaterale. Nel sospetto di rottura tendinea, veniva effettuata una risonanza magnetica che mostrava una lesione a livello della giunzione mio-tendinea, associata a marcata disomogeneità del tendine diretto. L'ecografia permetteva di confermare la presenza di entrambe le lesioni e di meglio definire le caratteristiche dell'entesite. Il caso in esame è tipico e conferma come la risonanza magnetica, per la sua panoramicità, sia da considerare l'esame di scelta nel dolore dell'anca, in particolare negli atleti professionisti; tuttavia, l'ecografia, per l'elevata risoluzione spaziale, si presenta come la tecnica di imaging ideale per la valutazione delle lesioni tendinee e può pertanto essere utilmente impiegata come esame di ...

Soccer players show the highest seasonal groin pain prevalence and the longest time loss from sport among 500 athletes from major team sports

“…No differences were found in the HAGOS values between these groups among the athletes with a history of groin pain during the previous season. Bortolotto et al [4] reported that the hip and the rectus femoris are commonly affected in volleyball professional athletes. The quadriceps muscle is involved in hip and knee joints and it is overstretched in the landing phase of the jump when the hip is extended and the knee is flexed; the muscle is therefore contracted and extended, and this increases the risk both of acute injury and of microtrauma leading to degenerative changes [31].…”

“…A group of international experts on the topic [6] stated that the available literature is mainly based on heterogeneous studies with low methodological quality. As far as we know, there are few studies on groin pain in team sport athletes such as basketball [9], volleyball [4], ice hockey [53, 54] and water polo [42] other than soccer [2, 10, 12, 17, 27, 28, 42–44, 46, 51]. Traditional epidemiological sports injury research on groin injuries has mainly focused on time loss injuries [51], defined as injuries resulting in a player not being able to participate fully in soccer training or match play [13].…”

Imaging of rectus femoris proximal tendinopathies

“…It is mostly isolated but association with MTJ strain has been previously described [27]. Apatite calcifications appear as a convex hyperechoic mass with posterior acoustic shadow and usually occur without previous history of trauma (Fig.…”

Sonography of the indirect tendon of the rectus femoris

“…Calcifications may also be related to hydroxyapatite deposition, and typically involve the dRF . Entheseal calcifications due to chronic microtraumas may also be seen . The examiner should remember that the use of excessive real‐time compounding affects the detection of calcifications as it masks their posterior shadowing.…”