Rectus abdominis muscle tear diagnosed with sonography and its conservative management
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CASE REPORT
Rectus abdominis muscle tear diagnosed with sonography and its conservative management Ashley N. Ruff1 · Stacey M. Cornelson1 · Austin S. Panter2 · Norman W. Kettner1 Received: 27 August 2019 / Accepted: 2 November 2019 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019
Abstract Purpose This is a rare case of a post-traumatic rectus abdominis muscle tear in an adolescent female diagnosed by ultrasonography (US). Conservative management is also described. Methods A 14-year-old female presented to a chiropractic clinic with extreme pain and tenderness in the right lower quadrant (RLQ) after post-plyometric power kneel box jumps. Movement aggravated her pain and she demonstrated active abdominal guarding with RLQ palpation. Ultrasonography revealed a subacute Grade 2 right rectus abdominis muscle tear, without evidence of hyperemia or a hematoma. Following the diagnosis of a right rectus abdominis muscle tear, she was treated with spinal manipulation and a course of musculoskeletal rehabilitation directed at truncal stabilization. Results After treatment, the patient was able to return to play 5 week post-injury without any pain or discomfort. A followup US at 3 months provided evidence of muscle healing without complications. Conclusion This case demonstrates the diagnosis of a rare rectus abdominis muscle tear managed conservatively. To our knowledge, less than a dozen cases are reported using US in the evaluation and diagnosis of a rectus abdominis tear. Keywords Rectus abdominis tear · Ultrasonography · Spinal manipulation · Muscle tear · Rehabilitation
Introduction Acute muscle injuries frequently occur in both amateur and professional athletes, with approximately 30% of sports injuries resulting in muscle injury [1–5]. The normal appearance of muscle fibers on ultrasonography (US) is arranged in a parallel hypoechoic manner surrounded by echogenic fibrofatty septa in pennate (long axis) and starry night (short axis) patterns. Disruption of the pennate and starry night pattern with enlargement, heterogeneity, and hypoechogenicity indicates a muscular tear [2, 3, 6–9]. Power Doppler may be used to detect local hyperemia or hematoma formation after muscular injury [10]. Muscle injury may occur as a result of external trauma leading to a contusion/compression rupture or from an indirect excessive tensile force leading to a distraction rupture.
* Ashley N. Ruff [email protected] 1
Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO 63017, USA
Winchester Sport and Spine, Troy, MO 63379, USA
2
Distraction ruptures are classified into grades depending on the extent of the tear [9, 11–13]. The most commonly injured muscles are the hamstrings, rectus femoris, and the medial head of the gastrocnemius. In acute injuries, the muscle is damaged from an eccentric action and typically occurs at the myotendinous junction, the weakest link within the muscle tendon unit. In passive muscle injuries, it is secondary to tensile overstretch in the a
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