Saturday, March 3, 2018

Later Thigh Injury


I  played basketball 3 days ago and received a knee to my lateral left thigh. It is tender to palpating over roughly a quarter size area. The pain feels superficial. There is no ecchymosis or swelling. No palpable deformity. Pain is exacerbated with hip deep flexion or knee hyper extension.

I put ultrasound to it.



I suspect this is the Vastus Lateralis muscle, though this may be Tensor Fasciae Latae.

Initial scan in short axis:



I was pretty surprised. I expected a deep hematoma or fluid collection. Instead, initial scan only revealed a "nubin" as seen circled with red. Normally I would think this was incidental, but it correlated directly to pain source. On better angling, (second photo) you can see the "nubin" prominently protrude downward from fascial plane into muscle. Whether this is an anatomical disruption, imaging overread, or actual injury, I'm not certain. 

I moved to long axis next.





Here I see more definitive evidence of muscle injury. The top and bottom photo have some definite disruption. The only problem is the tubular shape: these could certainly be vascular structures (particularly in the middle photo, which respects fascial planes). I forgot to Doppler, which would have solved my question. That being said, fibrillar disruption are irregular and were not seen throughout the remainder of the Vastus Lateralis exam, suggestive of muscle fiber disruption injury. Note the hypoechoic structure underlying muscle body is the Femur.

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