Distal Gracilis Tear in an Equestrian.

This is a case study of a 61-year-old equestrian woman who developed a rare high-grade partial thickness tear in the distal gracilis muscle, typically associated with vigorous exercise. Through physical therapy and ultrasound-guided corticosteroid injections, she was able to resume horseback riding after 12 weeks.

Introduction and Patient Presentation

• A 61-year-old female equestrian experienced sudden pain in her left medial thigh after exiting a car, without any recent history of trauma or falls.
• Upon clinical examination, there was a noticeable tenderness at the left distal medial thigh along with a palpable decrease in tissue volume at the gracilis myotendinous junction.

Diagnosis and Treatment

• Point-of-care ultrasound and magnetic resonance imaging (MRI) were used to diagnose the issue. They confirmed a high-grade partial tear of the left distal gracilis at the myotendinous junction, and a distended pes anserine bursa.
• The patient received physical therapy as part of her treatment regimen.
• Moreover, she underwent a one-time ultrasound-guided corticosteroid injection to the left pes anserine bursa to reduce inflammation and pain.

Follow-up and Outcome

• At the follow-up checkup, it was observed that the patient’s symptoms had significantly improved.
• She was able to return to her equestrian activities after 12 weeks from the onset of her injury.

Discussion

• Isolated gracilis myotendinous tear is a rare event and this case is unique due to the atypical mechanism of injury. Normally, gracilis injuries are reported during intense exercise-related activities rather than transitional movements, like exiting a car.
• The case indicates a potential increased risk of distal gracilis injury due to repetitive corticosteroid injections. The patient had received repeated genicular nerve blocks and radiofrequency lesioning, which could have predisposed her to gracilis microtrauma.
• Additionally, it was noted that her participation in equestrian activities might have also increased her vulnerability to this type of microtrauma.
• Gracilis injury, although rare, should be considered as a potential cause for distal medial thigh pain, especially in patients with a consistent interventional and recreational profile.