Patient

0 19 year old Mens Soccer Patient

0 Injured 10/21
0 C/O
0 MOI: Running
0 Right quadriceps pain (6.5/10)
0 Pain with walking up stairs
0 Has previous history of right ASIS avulsion fracture
 Evaluation
0 Swelling distal 1/3 of quadriceps just superior to patella.
0 Pain along distal 1/3 of Vastus Lateralis and Rectus Femoris
on palpation
0 Hip flexion and knee extension caused him the most pain
0 MMT: Knee extension and hip flexion 4+/5
0 Gaenslen's Test caused pain
0 Obers-negative
0 Rectus femoris test was able to perform test-test was negative
but caused pain
 Plan
0 Begin rehabilitation for grade 1 Quad Strain
 Re Evaluations
0 10/30 (approximately 1 week post injury)
0 Comes in ATR c/o ITB pain/tightness
0 Pain also on quad tendon
0 Continued rehab
0 10/31
0 Came in with significantly more pain. Obvious Swelling in distal 1/3 of
quad with more tenderness on quad tendon and increased pain over
proximal ITB
0 11/2
0 Saw Dr. Lukch
0 Apparent Quad Strain with resultant hematoma or Morel Lavalle Lesion
0 Xray and MRI
0 11/21
0 Athlete has progressed a little with rehabilitation. Xray came back clear
(ruled out fracture) and MRI Scheduled for 11/27
 Morel-Lavalle lesions
0 Morel-Lavalle lesions are closed degloving injuries
sustained during violent soft tissue shear that
separate the sub dermal fat from its strong underlying
fascia.
MRI
 Diagnosis
0 MRI Showed
0 Tearing in the muscle belly of the Vastus Intermedius
0 intramuscular hematoma in the Vastus Intermedius.
0 Partial Tearing of the Vastus Lateralis
0 Partial tearing at the proximal fascia tendon.
 Treatment
0 Continue with rehabilitation
0 If no improvements shown referral to physician