Heterotopic ossification of the indirect rectus femoris tendon

Heterotopic ossification with severe tendinosis of the indirect tendon of the rectus femoris and mild tendinosis of the direct tendon

Clinical information

Male, 32 year, physiotherapist and recreative soccer player with acute onset of ventral hip pain during a soccer game since 3 months.
Sharp pain. Provocation of pain during walking, starting-up, sports activities. Reduction: rest and adjusting load. Presumably normal course of the complaint. NPRS: at first: 8, at the moment 0, during sport activities: 7. No prior history of ventral hip pain.

Brief description

After 3 months mild pain during sport activities and pain free at rest. Injury mechanism: extension, exorotation and abduction hip with ipsilateral rotation of the trunk. Ultrasound findings: Shape: severe thickened indirect tendon, mild thickened direct tendon Echogenicity: hypo echoic indirect tendon, hyper echoic part around the intramuscular part of the tendon Continuity: abnormal fibrillary pattern of the indirect tendon, normal fibrillary pattern of the direct tendon Doppler: grade 0 doppler signal

Ultrasound Images & Clips

Indirect tendon longitudinal (lateral approach)
Indirect tendon longitudinal (lateral approach)
Direct tendon longitudinal (ventral approach)
Direct tendon longitudinal (ventral approach)
Indirect tendon transverse (lateral approach)
Indirect tendon transverse (lateral approach)
Direct tendon transverse (ventral approach)
Direct tendon transverse (ventral approach)
Indirect tendon measurement transverse (lateral approach)
Indirect tendon measurement transverse (lateral approach)
Indirect tendon measurement longitudinal (lateral approach)
Indirect tendon measurement longitudinal (lateral approach)
Indirect tendon longitudinal PD grade 0 (lateral approach)
Indirect tendon longitudinal PD grade 0 (lateral approach)
Direct tendon transverse PD grade 0 (ventral approach)
Direct tendon transverse PD grade 0 (ventral approach)
Rectus femoris muscle transverse with hyperechoic region
Rectus femoris muscle transverse with hyperechoic region
Indirect tendon longitudinal other side normal (lateral approach)
Indirect tendon longitudinal other side normal (lateral approach)
Inderect tendon insertion longitudinal other side normal (lateral approach)
Inderect tendon insertion longitudinal other side normal (lateral approach)
Indirect tendon transverse other side normal (lateral approach)
Indirect tendon transverse other side normal (lateral approach)
Direct tendon other side normal
Direct tendon other side normal
Rectus femoris muscle transverse other side normal
Rectus femoris muscle transverse other side normal

Conclusion

Moderate to severe tendinosis of the indirect rectus femoris tendon with heterotopic ossification and mild muscular scar tissue around the intra muscular indirect tendon. Possibly due to the previous injury in the past, mild tendinosis of the direct tendon.

Details

  • Sex: Male
  • Age: 32
  • Body part: ventral hip