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musculoskeletal imaging

FIGURE 1. Axial T2-weighted, fat-saturated magnetic resonance image of the right hip, showing loss of the normal low signal of the rectus femoris tendon at its origin from the anterior inferior iliac spine (AIIS) (arrow), with associated cortical disruption of the AIIS. These findings are consistent with a complete avulsion tear of the rectus femoris muscle. Surrounding heterogeneous signal represents soft tissue edema and heterotopic ossification.


FIGURE 2. Coronal T2-weighted, fat-saturated magnetic resonance image of the left hip, showing heterotopic bone formation (arrows) beginning at the origin of the rectus femoris muscle and extending into its myotendinous junction and surrounding soft tissues.

Heterotopic Ossification in a Recreational Soccer Player BEN HANDO, PT, DSc, Physical Therapy Services, National Defense University, Fort McNair, Washington, DC. JAY FLOTTMANN, MD, National Defense University, Fort McNair, Washington, DC. RAJ TULI, MD, Keesler Medical Center, Biloxi, MS.


he patient was a 44-year-old man who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of intermittent right hip pain that began 6 months prior while playing soccer. The patient participated in recreational soccer several days a week and also worked as a professional soccer referee. One week after the injury, he returned to playing soccer and was unable to kick forcefully with his right leg. He also experienced pain at night in his anterior right hip that disrupted his sleep. Visual observation revealed a large, oval-shaped mass 1 cm distal to the right anterior superior iliac spine that extended

10 cm distally. The mass was firm and was not tender to palpation. The patient’s hip passive range of motion was restricted in all planes, with hip flexion and internal rotation range of motion being most limited and painful. Strength testing of the hip and knee musculature was normal and pain free. After discussing the patient’s presentation with an orthopaedic surgeon, due to concern for nonmusculoskeletal pathology,1,2 the physical therapist ordered magnetic resonance imaging, which revealed an avulsion tear of rectus femoris tendon from the anterior inferior iliac spine, with surrounding soft tissue edema and heterotopic ossification (FIGURES 1 and 2).

In order to further characterize the heterotopic ossification, conventional radiographs and computed tomography were ordered and revealed extensive dystrophic calcification within the soft tissues of the right hip, associated with the rectus femoris myotendinous junction extending to its origin (FIGURES 3 and 4, available online at The patient subsequently underwent surgical excision of the heterotopic ossification, following which his night symptoms resolved and he was able to return to running and soccer without pain or functional limitation. t J Orthop Sports Phys Ther 2015;45(1):45. doi:10.2519/ jospt.2015.0401

References 1. Park JH, Kang CH, Kim CH, Chae IJ, Park JH. Highly malignant soft tissue sarcoma of the extremity with a delayed diagnosis. World J Surg Oncol. 2010;8:84. http://dx.doi. org/10.1186/1477-7819-8-84 2. van Vliet M, Kliffen M, Krestin GP, van Dijke CF. Soft tissue sarcomas at a glance: clinical, histological, and MR imaging features of malignant extremity soft tissue tumors. Eur Radiol. 2009;19:1499-1511. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Army or Department of Defense. journal of orthopaedic & sports physical therapy | volume 45 | number 1 | january 2015 |

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Heterotopic ossification in a recreational soccer player.

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