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Author Topic: partial Quad rupture but not sure which part(s)  (Read 3586 times)

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Offline nmdkneedo

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partial Quad rupture but not sure which part(s)
« on: September 04, 2014, 02:15:46 AM »
My quad ruptured during power cleans 17 days ago.  A PA in the ER took xrays and referred to the ortho surgeon.  He took a quick look 3 days later and said he thought it was in the muscle belly and could not be repaired.  He did order the MRI (imaged 2 days later) and consulted me again 6 days later (11 days post injury at 2nd meeting).  He thinks it is the intermedius and that there is some avulsion (at that 2nd meeting).  He also said to try walking in the straight-leg brace without crutches.  I continued the crutches for fall-protection, but tried to do some walking (peg-leg style).  He ordered some PT, which I started today (17 day post inj.).  I did some flat walking in recent days, even without the brace, but keeping the leg straight.  Today, the PT showed me some flexion exercises to add to basic quad sets and leg raises.  It is stiff from the long bout with only micro flexion motion.

I am concerned!  I wish I would have gone for a second opinion right away.  Maybe I can still try for a better long term outcome by doing so.  If the intermedius is torn "completely" and other muscles are only partially damaged, isn't it still a complete tear?  Is there nothing to be done if the tendon and bone are not involved, and could the torn ends re-attach to one another without surgery?  Is it too risky to repair avulsion of the intermedius (being deep to the other muscles)? 

I will fill in some details later, but for now, I am dealing with finding a physician who can do a thorough assessment and propose whether or not to repair it and how to proceed with therapy.  I looked up a few doctors in the St. Louis area, but if anyone knows someone to consider, please let me know.  I'm about 30 miles North-East in IL. 

Thanks for any ideas to consider, and again, I will discuss more specifics as I get the immediate issues addressed.

Offline fishy

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Re: partial Quad rupture but not sure which part(s)
« Reply #1 on: September 04, 2014, 09:45:18 PM »
Fishy here.  Welcome to the club.  Take a deep breathe....now, where are you from?  It does sound to me that you need additional evaluation....Read these threads until you get a better understanding.  John42 will reply to you shortly...follow his directions.  You have had a serious injury and you have a journey ahead of you....Patience, RICE, and get the 2nd/3rd or? until you are satisfied you have been evaluated correctly.  Bob

Offline nmdkneedo

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Re: partial Quad rupture but not sure which part(s)
« Reply #2 on: September 06, 2014, 01:44:52 AM »
Thank you Fishy,

~40 minutes NE of St. Louis (IL side of river)

I got an appt. next week with an ortho, but I cancelled due to my schedule, and also due to uncertainty about the doc.  Ortho surgeons donít seem to be profiled for specialization/expertise in quad tears. 
   -----------------------------------------------------------

3-Sep   1st PT visit; started bending leg
           Can set quads and hamstrings and move through the short range of motion
9/4 - 5   Walking on leg but can't fully extend (few degrees short), let alone get full flexion (already 
                 approaching 90 deg).  Leg doesn't feel stable
9/5             Can bend enough to drive now
                 19 days since injury
      -----------------------------------------------
The healing is impressive, but I wish it didnít feel like function might be compromised long-term by a torn muscle left unattached.  Granted, it could probably also be overly aggressive to do surgery when there is substantial function. 

Can a surgeon repair the intermedius (any one muscle) without damaging intact muscle-tendon?

Here are a couple articles I came across on the internet:
http://www.drdavidgeier.com/quadriceps-tendon-rupture/
http://www.drdavidgeier.com/ask-dr-geier-quadriceps-tendon-rupture/

Offline nmdkneedo

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Re: partial Quad rupture but not sure which part(s)
« Reply #3 on: September 06, 2014, 04:16:39 AM »
I got a copy of the MR images and report.  Following, are some findings by the radiologist:

HISTORY: quadriceps pain post weight lifting injury on

COMPARISON: None

TECHNIQUE: Multiplanar multi sequence noncontrast images of the right knee are reviewed.

Findings:
The marrow signal intensity distal femur proximal tibia, fibula and patella appear normal.

The patellar tendon is intact. ACL and PCL are normal. The iliotibial band, LCL and MCL are intact. The posterior horn of the medial meniscus demonstrates grade 2 signal. The body of the anterior horn demonstrates grade 1 noncommunicating hyperintense signal. The cartilaginous signal is preserved.

The examination demonstrates a grade II tear of the vastus intermedius with an intramuscular hematoma measuring 1.5 cm. The vastus medialis is intact demonstrating mild edema signal intensity. Hyperintense signal within the medial retinacular soft tissues is noted. There is a partial-thickness tear of the vastus medialis contribution to the patellar tendon. The mid and lateral aspect the patellar tendon are intact. The vastus lateralis is intact. The hamstring musculature appears normal.

IMPRESSION:

1. Examination demonstrates a grade II tear of the vastus intermedius with a 1.5 cm hematoma within
    the distal vastus intermedius.
2. There is a partial-thickness tear of the medial 25% of the medial fibers of the patellar tendon which
    arise from the vastus medialis. An avulsion or complete full-thickness tear of the quadriceps tendon
    is not present para
3. Edema signal intensity is noted within the vastus medialis.
4. Edema signal intensity and a partial thickness tear is noted within the medial retinacular soft tissues.
5. There is a moderate joint effusion present.


Offline fishy

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Re: partial Quad rupture but not sure which part(s)
« Reply #4 on: September 10, 2014, 09:53:54 PM »
Fishy here again....NMDKneedo.....thanks for the follow up.  Wow.....now the really big question... did you get a 2nd opinion?  You now have enough info to act accordingly but you need to get the 2nd opinion to give you the information to find a course of action...good to hear that the tendons were not completely torn ;D but the rest need to be considered by a professional.  My opinion.  You do not want to further injure the affected area.  From my experience:  I had initially partially torn my ligaments and did a water aerobics class, hot tub and then walking to my car RUPTURED the tendon and full muscle separation.... you do not want to duplicate my experience.  Bob

Offline nmdkneedo

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Re: partial Quad rupture but not sure which part(s)
« Reply #5 on: September 11, 2014, 04:32:31 PM »
I called several offices in St. Louis area about a 2nd opinion.  Some said they won't bill or accept my insurance.  One said to clear with the insurance first. One place didn't say much about the insurance; though I think I told them the company. Maybe they were satisfied with it or assumed I would pay up front and deal with insurance later (may be I should plan that way).  I had identified a doctor beforehand that I thought might be a good asset for my case, but I did not specify with the office, and I let them book me with someone who was available.  Then, I called the insurance company and got all kinds of road-blocks.  The doctor's profile was ok, but I could not detect any special expertise bearing on my case.  The appointment was a bit further out than the well renowned networks serving Barnes Hosp., St. Louis U., Wash U., and others in St. Louis.  I canceled the the appointment, thinking I might just as well pick a renowned expert at Barnes or SLU, and especially if I might have to pay out of pocket anyway.

I have lost more time now.  My primary care physician returned my query about a second opinion through his nurse.  The communication channel is not great, and he needs to see me to make a referral.  I am pretty sure that he won't easily refer me across the river to St. Louis, MO due to Insurance pressures.  Maybe, I can do fine without that, I don't know.  So, I am on the fence and juggling, but still keen to take some action.

Meanwhile, the leg is "healing", as they tend to do.  The ortho seems happy with his choice, regardless that I will dearly miss having function of my now avulsed intermedius.  I'll get back to the knee issues in a later post.

I am very sorry to hear of your injury/re-injury.  That second episode must be even harder to deal with.  Water aerobics and a hot tub would seem to have a therapeutic effect, but I guess there are some mechanisms where fatigue and maybe fluid-shifts can precipitate the injury.  Did you have it back in a brace on the way to the car, and did you happen to mis-step or stumble?

Offline carkeltom

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Re: partial Quad rupture but not sure which part(s)
« Reply #6 on: September 15, 2014, 09:37:03 PM »
nmdkneedo.  Hey there.  I live northwest of St. Louis on the MO side.  I had a bilateral patellar tendon rupture last July.  I am not sure if there are any orthos in the area that deal with your injury in particular.  I went with the SSM group, as that was nearest to me as the ambulance ride was a long one.  I am not sure who specializes although SLU and Wash U might be the best.  Mercy is in Illinois also I think.  Sorry to hear about the injury.  I hope it is not a full tear.  Going thru one would be hard and two is worse, but I feel your pain. 
Tom
Bilateral patellar tendon rupture 7/19/13

Offline nmdkneedo

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Re: partial Quad rupture but not sure which part(s)
« Reply #7 on: September 16, 2014, 03:05:26 AM »
Thank you for the post carkeltom.  I hope you are one the mend by now. 

I looked into the SSM group.  There seem to be a few SSM hospitals in that area, and maybe some of the physicians work two or more hospitals.  One ortho practice group has about 15 orthos in it. 

I saw my primary care doc on Friday to get a referral for a second opinion.  I asked, "Do some get referred to Barnes or SLU?".  He said yes, but did not jump at the chance to refer me to anyone specific (don't think he follows who is who in ortho).  He submitted something to the insurance; I already know they have the whole thing constrained to their network (nothing in St. Louis or MO).  So, I probably have to pay out of pocket to go to Barnes, SLU, Wash U., other in MO,  OR  settle for someone in network. 

Offline nmdkneedo

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Re: partial Quad rupture but not sure which part(s)
« Reply #8 on: September 16, 2014, 03:11:35 AM »
Elevating the leg is still helpful to reduce the full feeling. Is that related to why I can't completely extend it?  The doctor suggested that it is now weak, but it feels like there is impingement. 

Offline nmdkneedo

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Re: partial Quad rupture but not sure which part(s)
« Reply #9 on: October 01, 2014, 09:02:55 PM »
Can/does anyone repair (sew) ruptured muscle tissue?

If a tear were partial, could ruptured fibers spontaneously attach to adjacent fibers (or fascia) and achieve some degree of ability to contribute tensile force?  Or rather, do they remain non-productive?  Then, is there any natural mechanism for a completely ruptured muscle belly to recover function?