Distal Gracilis Tear in an Equestrian.
Abstract: A 61-yr-old female equestrian presented after 2 wks of left medial thigh pain, which developed suddenly while exiting a car. She denied any history of recent trauma or falls. On examination, she was found to have tenderness at the left distal medial thigh with a palpable region of decreased tissue volume at the gracilis myotendinous junction. Point-of-care ultrasound and magnetic resonance imaging confirmed a high-grade partial thickness tear of the left distal gracilis at the myotendinous junction, as well as pes anserine bursal distention. She received physical therapy and underwent a 1-time ultrasound-guided corticosteroid injection to the left pes anserine bursa. At follow-up, her symptoms had significantly improved, and she had returned to horseback riding after 12 wks. Isolated gracilis myotendinous tear is a rare condition, and this is a unique case with an atypical mechanism of injury as gracilis injuries have only been reported during vigorous exercise-related activities rather than transitional movements. This case illustrates the potential increased risk of distal gracilis injury after repetitive corticosteroid injections (genicular nerve blocks and radiofrequency lesioning) in a patient who was also likely predisposed to gracilis microtrauma due to her equestrian activities. Gracilis injury should be considered in the differential diagnosis of distal medial thigh pain, especially in cases with similar interventional and recreational profiles.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Publication Date: 2021-07-29 PubMed ID: 34320562DOI: 10.1097/PHM.0000000000001854Google Scholar: Lookup
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Summary
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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.
Cite This Article
APA
Chen YT, Mills C, von Rickenbach KJ, McInnis KC.
(2021).
Distal Gracilis Tear in an Equestrian.
Am J Phys Med Rehabil, 101(1), e8-e10.
https://doi.org/10.1097/PHM.0000000000001854 Publication
Researcher Affiliations
- From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts.
MeSH Terms
- Animals
- Athletic Injuries / complications
- Athletic Injuries / diagnosis
- Diagnosis, Differential
- Female
- Gracilis Muscle / injuries
- Horses
- Humans
- Middle Aged
- Musculoskeletal Pain / diagnosis
- Musculoskeletal Pain / etiology
- Tendon Injuries / diagnosis
- Tendon Injuries / etiology
- Thigh / injuries
Conflict of Interest Statement
Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.
References
This article includes 12 references
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Citations
This article has been cited 1 times.- Jin QH, Liu Y, Yin XY, Zhou XG, Liu WG, Yin QF. Technique of Distal Tendon Excision for the Treatment of Chronic Pain Caused by Isolated Proximal Gracilis Tears. Arthrosc Tech 2024 Nov;13(11):103099.
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