Intramuscular degloving injury

Last revised by Joachim Feger on 9 Feb 2024

An intramuscular degloving injury is a term referred to as a circumferential intermuscular dissociation of inner and outer muscular components with or without retraction. It has been described in the rectus femoris muscle.

An intramuscular degloving injury has been also described as a bull’s eye lesion and lesion with a ‘muscle-within-a-muscle’ appearance.

Intramuscular degloving injuries account for about 9% of rectus femoris muscle injuries 1.

Factors that increase the likelihood of developing an intramuscular degloving injury include:

  • kicking motions

  • recent or remote injury

  • low muscle strength

  • muscle fatigue

  • inadequate warm-up

  • improper technique

Intramuscular degloving injuries can be associated with other types of muscular injuries of the same or different muscles or muscle hematoma.

Symptoms are quite variable and patients can present with thigh pain and/or hip pain, discomfort thigh enlargement with variably associated strength deficit.

If left untreated an intramuscular degloving injury probably leads to re-injury and focal or diffuse muscle atrophy with fatty replacement.

Especially kicking has been described as a mechanism leading to a degloving injury of the rectus femoris muscle, sprinting and forced quadriceps extension are other mechanisms.

This type of tear has been described in a setting of a rectus femoris muscle injury, where the peripheral fibers of the inner indirect head (bipennate muscle) are separated from the overlying direct head (unipennate muscle).

Plain radiographs might show soft tissue swelling.

On ultrasound, an intramuscular degloving injury has been described to show a muscle-within-a-muscle appearance showing an area of mixed echogenicity surrounding the inner indirect head of the rectus femoris muscle with the transducer in the axial plane.

An intramuscular degloving injury can be visualized on fat-saturated T2 weighted or intermediate-weighted MRI images.

The inner part of the bipennate indirect head of the muscle is usually surrounded by fluid dividing it from the outer muscle fibers of the unipennate direct head and might be retracted proximally.

The radiological report should include a description of the following:

  • the location and extent of the injury

  • the extent of muscular retraction of the dissociated indirect head

Similar to other rectus femoris muscle injuries degloving injuries can be managed conservatively.

Conservative management includes activity modification with an initial resting period, cryotherapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) followed by an active and comprehensive rehabilitation protocol with physical therapy early motion and light running exercises, over-strengthening exercises, endurance and agility training. The rehabilitation protocol can comprise different stages to facilitate and improve return to activity 5.

Recovery from this type of injury partially depends on the extent of tendon retraction and has been reported to take 5-6 weeks on average.

Hughes et al in 1995 first described a tear of the deep myotendinous junction of the indirect head of the rectus femoris muscle on MRI and spoke of a ‘bull’s eye lesion’, Bianchi et al. and Balius et al. described the condition on ultrasound as a ‘muscle-within-a-muscle’ appearance. Kassarjian et al. used the term ‘intramuscular degloving injury’.

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