Stephen Bird

Hi Jo,

Lovely images,

The quadriceps can be tricky to navigate, especially rectuf femurs as it has three intramuscular tendons to consider and is in essence a muscle inside another muscle.
I think it is unique in many ways.

I am currently recording a webinar on this muscle for the upcoming ASA meeting and as soon as they have shown it I will put it on the website for you to enjoy. I am also doing one on the calf injuries.

You will enjoy them when I load them up soon,

Your case is interesting.

Musacles can be damaged by overloading (over-stretching) the muscle leading to tendon tears and MTJ tears. There is also the concept of myofascial tears which I am less of a believer as I feel most of these can be allocated MTJ status from the intramuscular tendon collagen.

The other mechanism is a crush injury where the muscle is compressed by external force and it bleeds leading to a haematoma. In these cases the haematoma does not need to be associated with any of the usual MTJ areas.

In your case I feel that external compression ands hematoma’s are the more likely answer.

The haematoma in vests intermedius is a classic and the other areas you have documented are also consistent with intramuscular hematoma’s following compression.
Was the patient taking any blood thinning medication (it would be common a that age) and may have contributed.
You do not get much external bruising as the blood is trapped inside the muscles fascia and can not reach the subcutaneous space.

I feel like you have multiple compression induced haematomas in the locations you perfectly describe rather than multiple MTJ or myofascial tear injuries.

Keep an eye out for the new presentations as they will provide a lot of additional information on this topic.

Happy scanning,


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