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Hip Flexor Injury
Kirkland W. Davis, MD, FACR; Adam C. Zoga, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Musculotendinous junction (MTJ), myotendinous unit (MTU), rectus femoris (RF)
            • Synonyms

              • Hip flexor, flexor strain, anterior hip strain
            • Definitions

              • Myotendinous, teno-osseous, muscle belly, or epimysial/myofascial lesion causing pain on active thigh flexion

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Lutterbach-Penna RA et al: Ultrasound of the thigh: focal, compartmental, or comprehensive examination? AJR Am J Roentgenol. 203(5):1085-92, 2014
                                            2. Mendiguchia J et al: Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med. 47(6):359-66, 2013
                                            3. Kassarjian A et al: Current concepts in MRI of rectus femoris musculotendinous (myotendinous) and myofascial injuries in elite athletes. Eur J Radiol. 81(12):3763-71, 2012
                                            4. Pierannunzii L et al: Case report: calcific tendinitis of the rectus femoris: a rare cause of snapping hip. Clin Orthop Relat Res. 468(10):2814-8, 2010
                                            5. Bui KL et al: Iliopsoas injury: an MRI study of patterns and prevalence correlated with clinical findings. Skeletal Radiol. 37(3):245-9, 2008
                                            6. Gyftopoulos S et al: Normal anatomy and strains of the deep musculotendinous junction of the proximal rectus femoris: MRI features. AJR Am J Roentgenol. 190(3):W182-6, 2008
                                            7. Sanders TG et al: Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):42-53, 2008
                                            8. Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
                                            9. Geraci MC Jr et al: Evidence-based treatment of hip and pelvic injuries in runners. Phys Med Rehabil Clin N Am. 16(3):711-47, 2005
                                            10. Niemuth PE et al: Hip muscle weakness and overuse injuries in recreational runners. Clin J Sport Med. 15(1):14-21, 2005
                                            11. Tyler TF et al: The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 29(2):124-8, 2001
                                            12. Emery CA et al: Groin and abdominal strain injuries in the National Hockey League. Clin J Sport Med. 9(3):151-6, 1999
                                            13. Khan K et al: Overuse injuries in classical ballet. Sports Med. 19(5):341-57, 1995
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Musculotendinous junction (MTJ), myotendinous unit (MTU), rectus femoris (RF)
                                                      • Synonyms

                                                        • Hip flexor, flexor strain, anterior hip strain
                                                      • Definitions

                                                        • Myotendinous, teno-osseous, muscle belly, or epimysial/myofascial lesion causing pain on active thigh flexion

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Lutterbach-Penna RA et al: Ultrasound of the thigh: focal, compartmental, or comprehensive examination? AJR Am J Roentgenol. 203(5):1085-92, 2014
                                                                                      2. Mendiguchia J et al: Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med. 47(6):359-66, 2013
                                                                                      3. Kassarjian A et al: Current concepts in MRI of rectus femoris musculotendinous (myotendinous) and myofascial injuries in elite athletes. Eur J Radiol. 81(12):3763-71, 2012
                                                                                      4. Pierannunzii L et al: Case report: calcific tendinitis of the rectus femoris: a rare cause of snapping hip. Clin Orthop Relat Res. 468(10):2814-8, 2010
                                                                                      5. Bui KL et al: Iliopsoas injury: an MRI study of patterns and prevalence correlated with clinical findings. Skeletal Radiol. 37(3):245-9, 2008
                                                                                      6. Gyftopoulos S et al: Normal anatomy and strains of the deep musculotendinous junction of the proximal rectus femoris: MRI features. AJR Am J Roentgenol. 190(3):W182-6, 2008
                                                                                      7. Sanders TG et al: Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):42-53, 2008
                                                                                      8. Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
                                                                                      9. Geraci MC Jr et al: Evidence-based treatment of hip and pelvic injuries in runners. Phys Med Rehabil Clin N Am. 16(3):711-47, 2005
                                                                                      10. Niemuth PE et al: Hip muscle weakness and overuse injuries in recreational runners. Clin J Sport Med. 15(1):14-21, 2005
                                                                                      11. Tyler TF et al: The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 29(2):124-8, 2001
                                                                                      12. Emery CA et al: Groin and abdominal strain injuries in the National Hockey League. Clin J Sport Med. 9(3):151-6, 1999
                                                                                      13. Khan K et al: Overuse injuries in classical ballet. Sports Med. 19(5):341-57, 1995