International Orthopaedics (SICOT) (1991) 15:167-168 International Orthopaedics

© Springer Verlag 1991

Isolated contracture of the long head of biceps femoris muscle

I. Matev

The Institute of Orthopaedics and Traumatology, 56 Petko Napetov Blvd, 1614 Sofia, Bulgaria

Summary . A rare case o f contracture o f the long head of biceps femoris in a soccer player is de- scribed. Degeneration was probably caused by re- peated corticosteroid injections. He made a ful l recovery after release o f the shortened long head.

Rbsumb. Description d'un rare cas de contracture de la longue portion du biceps fbmoral chez un foot- balleur professionnel. II est trOs probable que la db- gbnbrescence de la partie proximale du muscle soit due gl des infiltrations multiples (19) de corticostb- ro~'des. Les troubles ant disparu aprds allongement par dksinsertion de la longue portion du biceps fk- moral.

Introduction

Cont rac tu re of the long head of biceps femor is is very rare and only one case has been found in the l i terature [1]. Calc i f ica t ion was present and pro- duced i rr i ta t ion of the sciatic nerve with rad ia t ing pa in which was aggrava ted by dors i f lex ion o f the foot. Excis ion of the affected muscle resul ted in comple te recovery.

This repor t adds a second case.

Case report

A Bulgarian, aged 28 years, who was a professional soccer player, complained of vague pain and a feeling of tiredness in

Fig. 1 a, b. Full forward bending is only possible when the knees are flexed

Fig. 2. After operation, he can bend with his knees extended

Reprint requests to: I. Matev

168 I. Matev: Contracture of the long head of biceps femoris muscle

the left thigh and buttock. He had several contusions of this area in the past which were treated by physiotherapy, and he had been given 19 injections of corticosteroid and lidocaine, some just before matches.

His complaints got worse gradually so that he could not play for more than 10 to 15 rain. He had to retire from profes- sional sport. He also had difficulty driving his car.

The radiographic appearances were always normal. On admission, there was slight wasting of the posterior

muscles of the left thigh. Deep palpation below the ischial tuberosity produced moderate pain. On increasing pressure the pain became more severe, was burning in character and spread along the course of the biceps femoris muscle. When he stood, there was a spindle-shaped thickening below the ischial tuberosity which disappeared when he flexed his knee. There was no sensory or motor deficit.

He sat on his right buttock, sparing the left. Bending with his knee extended produced pain in the left thigh (Fig. 1). He was only able to bend forward freely when his knees were flexed. He had no pain when standing with his left knee flexed 30 °, but a varus strain produced pain.

At operation under general anaesthesia, the proximal end of the long head of biceps was found to be thickened to 2 fin- gers' breadth, white in colour and as hard as cartilage. The muscle was stretched when the knee was extended and relaxed on flexion. The thickened part of the muscle was lying over the sciatic nerve. The long head was detached from the ischial tuberosity, displaced 4 cm distally, and sutured to the semiten- dinosus and semimembranosus tendons.

Microscopy showed dense intratendinous fibrosus extend- ing around the tendon, with some signs of inflammation.

Full load-bearing was allowed 45 days after the operation and he could then bend forward with his knees extended (Fig. 2). At 4 months he returned to playing in a Bulgarian team and during a national championship scored 4 goals. Fol- low up after 6 years showed normal function and no com- plaints.

Discussion

In this case tendinous degeneration was probably due to repeated injections of corticosteroid into and around the tendon. Pain was attributed to tension in the shortened muscle during effort, as well as to pressure on the sciatic nerve. Radio- graphs did not show calcification. Treatment was by operative release of the affected muscle and this produced complete recovery.

Reference

1. Dashevsky JH (1973) Calcific degeneration in the tendon of the long head of biceps femoris. J Bone Joint Surg [Am] 55:211-212