Golfer's Elbow Treatment

About Golfer's Elbow

Golfer’s elbow – also called pitcher’s elbow – is a repetitive overuse syndrome that manifests as medial epicondylar pain. Golfer’s elbow arises from overuse of the musculature of the wrist and hand whose proximal tendons attach at the elbow. Medial epicondylitis is caused by using repetitive force to flex the wrist forward. It often involves irritation or entrapment of the ulnar nerve where it travels through the cubital tunnel.

Golfer’s elbow can be stubborn to treat due to the low vascularity of elbow tendons and ligaments. In some cases, more than one condition affects the elbow, and they need to be treated simultaneously. Addressing the symptoms of elbow pain is not enough to resolve golfer’s elbow – we need to consider the entire chain of structures from fingers to shoulder. Myofascial connections need to be examined, and mechanical issues that contribute to medial epicondylitis should be corrected.

A Case Study on Holistic Golfer’s Elbow Treatment

A recent case study highlights the potential benefits of integrative holistic therapy for golfer’s elbow. Our patient was a 40 year-old male bodybuilder and wrestler complaining of acute pain in the medial elbow. A physical exam followed by ultrasound imaging led to a diagnosis of left medial epicondylitis, with irregular characteristics and increased blood flow. Moderate pain at rest intensified dramatically with movement.

During the previous two years, the patient had received manual deep massage therapy, transcutaneous electrical nerve stimulation, hydrotherapy, and injections of lidocaine and corticosteroids, none of which effectively reduced his pain and disability. Three months prior to dry needling treatment, he had stopped all therapy and physical training except for walking on a treadmill at submaximal intensity.

As a holistic treatment approach, the patient received dry needling on his medial epicondyle and the inner side of his left elbow. Ten needles were inserted vertically and left in place for 20 minutes. Ice was administered after the needles were removed to minimize pain and inflammation

The patient reported no changes in his pain level or range of motion immediately after dry needling, but when he returned two days later for a follow-up exam, he reported improved elbow function and reduced pain. Seven days after the dry needling session, he was able to start exercise training again without pain or limitations.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Tendinopathy Specialist Dr. Lev Kalika

With over 25 years of experience treating tendinopathies, Dr. Kalika has formulated his own unique approach to diagnosis and treatment. As an expert in diagnostic ultrasonography, he has published multiple scientific publications that have helped to take diagnostic medicine to the next level.

Based on the latest scientific evidence and years of experience treating medial epicondylitis, Dr. Kalika considers not only the wrist and elbow, but also the complexities of the upper arm kinetic chain when diagnosing medial epicondylitis. His expertise in high resolution ultrasonography allows him to visualize the elbow and its associated structures in real time, to identify all factors that contribute to golfer’s elbow.

Dr. Kalika’s expertise in ultrasonography makes him one of the most sought-after specialists in NYC for diagnosing and treating golfer’s elbow.

High Resolution Imaging is Key to Accurate Diagnosis

Diagnosis of medial epicondylitis is often symptoms-based, but that approach can result in mistreatment or undertreatment, prolonging the patient’s pain and increasing medical costs. Dynamic high resolution ultrasound imaging lets us see the big picture in real time, with the elbow in motion.

With diagnostic ultrasound, we can:

  • Compare the injured and uninjured elbows
  • View nerves, muscles, fascia and bones along their entire path
  • Identify fascial densifications and adhesions, and myofascial trigger points
  • Detect the exact site of nerve compression or entrapment
  • View multiple tissues and structures in a single session
  • Elicit patient feedback during the imaging session

Ultrasound imaging takes the guesswork out of diagnosis and ensures that the multiple factors that contribute to golfer’s elbow are identified and treated. Ultrasound imaging takes place on-site, in the comfort of our clinic on your very first visit. Quick and accurate diagnosis means you can begin therapy right away, with no wait time for lab results.

Ultrasound vs MRI for Visualizing Medial Epicondylitis

For years, MRI has been considered the gold standard for musculoskeletal imaging, but advancements in technology have catapulted high-resolution diagnostic ultrasonography to the top of the heap.

Why high resolution ultrasound is superior to MRI:

  • Much higher resolution means ultrasound can visualize small lesions and anomalies that are often missed by MRI
  • Ultrasound allows for dynamic evaluation that can reveal factors like ligament laxity, ulnar nerve entrapment, and other conditions that mimic golfer’s elbow, factors that cannot be detected by static MRI
  • High-resolution ultrasonography can visualize compression or entrapment of the medial cutaneous antebrachial and/or medial brachial nerves, which can mimic golfer’s elbow and are impossible to visualize with MRI

Ultrasound-Guidance makes Our Therapies More Accurate and Effective

Because golfer’s elbow and tennis elbow are fairly common conditions, many doctors are quick to diagnose elbow epicondylitis based on symptoms alone, without ruling out other potential issues. Consequently, patients often go mistreated or undertreated, prolonging their pain without resolving their condition.

Recent research on elbow epicondylitis was presented at the International Society for Medical Shockwave Treatment (ISMST) Congress:

  • In one study of 56 patients who had been diagnosed with elbow tendinopathy, 16 percent (9 patients) had nerve compressions, and 32% (18 patients) had pain generated from trigger points.
  • In another study of 51 patients diagnosed with insertional epicondylar tendinopathy, one had humeral osteochondritis, and another had radio-ulnar synovitis.

Without ultrasound imaging, diagnosis of elbow epicondylitis is a hit-or-miss proposition. Misdiagnosis can cause critical conditions to go untreated, costing the patient time and money while prolonging their pain and dysfunction.

Tensegrity is the Secret to Pain-Free Mobility

Most people take everyday mobility for granted until an injury occurs or pain sets in. Sometimes pain and reduced mobility seem to arise out of nowhere, with no apparent cause of onset. Regardless of whether your pain is caused by trauma or by something less obvious, tensegrity plays a key role.

Tensegrity refers to tensile integrity – a state where a system of individual components is held together under continuous elastic tension. In the human body, tensegrity is created by the myofascial system, the network of muscles and fascia that work together to produce, control, and guide forces, and to hold the body’s various organs and structures in place during movement.

Tensegrity can be disrupted when myofascial tissues are injured or damaged in some way. When that happens, nerves and blood vessels can become entrapped, preventing them from gliding among other structures and producing pain. At the same time, the elastic tension that governs joint alignment and controls movement becomes compromised, creating motor deficits that undermine mobility and stability.

Factors that disrupt myofascial tensegrity include:

  • Traumatic injury that affects multiple tissue types
  • Overuse injuries from sports, exercise or occupation
  • Old injuries that were never properly rehabilitated
  • Sedentary lifestyle with excessive sitting
  • Obesity that overloads the body’s structures
  • Inadequate hydration that deprives soft tissues of water needed to function
  • Diet high in sugar and carbs that causes myofascial tissue glycation, making it dense and sticky

Many doctors do not understand the crucial role of the myofascial system in preventing pain syndromes, movement disorders, and disease. In fact, most medical doctors have no idea how to correct myofascial dysfunction or even recognize it as a factor. They simply treat pain symptoms with medications and eventually recommend surgery.

At NYDNRehab, we understand that the body’s systems work together as an integrated whole, and that treating pain is not enough to eliminate its source. We use dynamic high-resolution ultrasound to explore the myofascial system in real time. Ultrasound imaging lets us visualize muscles, fascia, nerves and other structures in motion, to identify places where tensegrity has been disrupted.

Once we identify the problem, we use the most advanced therapeutic approaches to restore myofascial integrity and promote tissue healing.

Why Physical Therapy Alone is Not Enough to Resolve Golfer's Elbow

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to pre-treat your condition can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

Obstacles to physical therapy success include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

At NYDNRehab, we use a broad range of regenerative technologies and integrative therapeutic approaches to resolve issues that can stand in the way of successful physical therapy. Our staff is certified in a diverse array of holistic treatment methodologies, and our one-on-one treatment sessions are personalized, based on your unique diagnostic profile.

Once we pre-treat your damaged tissues and eliminate compensation patterns, your body will be ready to begin physical therapy.

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Our Regenerative Therapies
Accelerate Healing

The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.

Regenerative Therapies At NYDNRehab

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave is a groundbreaking regenerative mechanotransduction technology that accelerates tissue healing. Its patented electro-hydraulic applicator delivers high-speed soundwaves that can penetrate up to six inches in depth. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. SoftWave’s wider and deeper penetration using defocused energy is a preferred treatment option for a broad spectrum of conditions, ranging from orthopedic injuries to pelvic health. SoftWave is the only unfocused shockwave technology currently available. According to recent research, SoftWave defocused waves combined with focused and radial shockwaves have maximum regenerative potential.


Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types with the most effective shockwave treatment.

Myofascial Acoustic Compression Therapy (MyACT)
Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.


Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT transmits high energy magnetic pulses to targeted tissues that synchronize with the body’s own magnetic fields, triggering a regenerative response. EMTT waves can penetrate deep tissues to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Magnetic Transduction Therapy (EMTT)
Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues, but has minimal regenerative properties.The mechanical properties of EPAT make it especially effective for fascial manipulation in combination with focused shockwaves. We combine EPAT with different types of shockwaves for holistic treatment, without additional cost to the patient.


High Energy Inductive Therapy (HEIT)

HEIT delivers high-intensity magnetic pulses to peripheral nerve tissues, to stimulate neuroplasticity. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, for enhanced motor control.

High Energy Inductive Therapy (HEIT)
INDIBA Radiofrequency Therapy

INDIBA Radiofrequency Therapy

INDIBA is a form of TECAR therapy that helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation.


NESA Neuromodulation Therapy

NESA generates a low-frequency electrical current of intermittent and cyclical stimuli that soothes hypersensitized nerves and restores optimal signaling between the autonomic nervous system and the brain. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, to enhance motor control.

NESA Neuromodulation Therapy

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start tendon healing in chronic injuries and accelerate repair in acute injuries.


Alpha-2-Macroglobulin (A2M)

Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in arthritic joints and helps to deactivate a variety of proteinases that typically degrade cartilage.


Prolotherapy

Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers.


Interfascial Plane and Nerve Hydrodissection

Running injuries often involve fascial tissue that has become densified and/or formed adhesions, entrapping nerves and blood vessels, causing pain and restricting movement. Hydrodissection is a procedure where a saline solution is injected into densified fascia under ultrasound guidance. The solution works by separating fascial layers and freeing up entrapped nerves and blood vessels. We often use hydrodissection in conjunction with manual fascial manipulation.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to musculoskeletal pain and dysfunction. The dry needling procedure inserts filament-thin non-medicated needles into trigger points to evoke a twitch response, relaxing contracted fibers and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing discomfort for the patient.

More Advanced Therapies at NYDNRehab

Our Therapies Icon

SM Neuromuscular Electrical Stimulation (SMNMES)

SM neuromuscular electrical stimulation (NMES) dynamically interacts with the patient during therapeutic exercises, providing real-time sensory, auditory and visual biofeedback to the patient. This breakthrough technology helps patients to recalibrate muscle actions, to optimize joint function. SMNMES has helped numerous patients to avoid unnecessary shoulder, knee and ankle surgeries, even in complex scenarios.

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Ultrasound Guided Percutaneous Neuromodulation (PENS)

During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle recruitment patterns. This therapy is so effective that patients typically need only 4-6 treatment sessions.

Symptoms and Causes of Medial
Epicondylitis

The most common symptoms of golfer’s elbow include:

  • Pain along the outer forearm from your elbow to your wrist
  • Pain when flexing your wrist forward
  • Pain when shaking hands
  • Weakened grip strength
  • Numbness and tingling from your elbow to your pinkie and ring fingers
  • Pain that worsens with gripping

Despite its sporty nickname, golfer’s elbow can arise from many
activities that overload the wrist and hand, including:

  • Playing golf
  • Painting walls and ceilings
  • Plumbing
  • Using construction tools
  • Cooking
  • Working on an assembly line

Golfer’s Elbow Treatment Options at NYDNRehab

At NYDNRehab we use a multifaceted approach to provide our patients with the very best treatment for golfer’s elbow.

Your treatment protocol may include:

  • Focused and radial extracorporeal shockwave therapy (ESWT)
  • Prolotherapy and/or PRP injection therapy
  • Ultrasound guided dry needling to eliminate myofascial trigger points
  • Stecco fascial manipulation therapy
  • Hydrodissection to release interfascial planes
  • Physical therapy to restore muscle balance and fascial tensegrity
  • Biomechanical analysis to optimize your golf technique

Your treatment protocol is customized based on your unique anatomical characteristics and patient profile. We measure and reassess along the way, to ensure your therapy is progressing toward pain-free function.

Get Personalized Epicondylitis Physical Therapy, Designed Just for You

At NYDNRehab, we treat the whole patient, not just your symptoms. We never use one-size-fits-all rehab protocols or antiquated recovery timelines. We believe that every injury is unique, and treatment should be based on a holistic approach that factors in the patient’s unique profile.

Once we have successfully pre-treated damaged tissues, we can begin one-on-one physical therapy to restore strength and stability, optimize mobility, and re-establish optimal neuromuscular pathways and muscle coordination patterns.

Your physical therapy protocol may include a combination of the following approaches:

  • Stecco fascial manipulation, to eliminate densifications and adhesions and restore fascia’s gliding properties
  • Postural restoration therapy to optimize total-body joint alignment
  • Dynamic neuromuscular stabilization (DNS) to restore developmental motor strategies
  • Integrated systems model (ISM) to optimize function and performance
  • Anatomy in motion (AIM) to enhance movement quality
  • Neurodynamics, to restore communication pathways between the brain and body
  • Conventional eccentric loading and strengthening exercises
Your back-to-sports physical therapy protocol may include sport-specific training to optimize motor skills and restore peak athletic performance. We carefully monitor patient progress with ultrasound imaging to confirm complete recovery.

Our High-Tech Equipment Produces Superior Results

Advancements in technology are changing the game in rehabilitative medicine, enabling us to accelerate healing and restore performance at an unprecedented pace. The clinic at NYDNRehab features some of the most advanced therapeutic equipment currently available, and rarely found in private clinics.

Your tendinopathy therapy may include the use of high-tech equipment:

C.A.R.E.N Computer Assisted Rehabilitation Environment

Originally developed to rehabilitate injured soldiers, this multifaceted system gives us a broad range of tools for assessment, feedback and performance enhancement. Dr. Kalka has integrated his own unique selection of technologies to optimize the ways in which C.A.R.E.N helps patients to achieve their goals.

DD Robotech

Artificial intelligence is gaining traction as an invaluable tool for evaluating patient strength, power and performance, and providing feedback to help restore the brain-body connection, post-injury. DD Robotech uses a data-driven approach to optimize patient performance and expedite tendon recovery.

Blood Flow Restriction Training (BFRT)

Rebuilding muscle strength while joints and connective tissues are still healing is a challenge for athletes who need to return to sport in the shortest time possible. BFRT enables you to increase muscle size and strength at much lower training volumes, to reduce stress on still-healing structures while rapidly restoring muscle performance.

Kineo Intelligent Load System

We use the Kineo intelligent loading system to create customized training and rehabilitation programs for our patients. With Kineo, we can customize variable load protocols for functional training, core training, agility drills and more. The Kineo variable resistance system lets us design a personalized variable load curve based on the needs of the individual patient.

Cryotherapy

Cold therapy has long been used for injury treatment and recovery from sports and exercise. Modern cryotherapy has replaced ice baths and ice packs with a dramatically faster and more convenient technology using nitrogen gas, directed via a specialized device to target injured tissues.

Preventing Golfer's Elbow

Golfer’s elbow, sometimes referred to as pitcher’s elbow or thrower’s elbow, refers to medial epicondyle pain. It is an overuse injury that has more to do with the wrist than the elbow, and the majority of people who get golfer’s elbow do not play golf.

Whether your condition arises from sports, occupation or everyday activities, there are several things you can do to reduce your risk:

  • Sports like golf and baseball impose large force loads on the wrist and forearm, causing pain in the elbow tendons to which the muscles are anchored. A biomechanical analysis can help troubleshoot faulty mechanics that distribute forces to the elbow.
  • If your pain is work-related, request an ergonomic analysis of your workstation to optimize repetitive movements.
  • Be proactive in the early stages of pain by reducing your activity or lowering your intensity. Apply ice to the painful tissues to reduce inflammation. If pain persists, seek holistic therapy to restore pain-free movement.
  • Do resistance training 2-3 times per week to promote strength and balance muscle tension.
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NYDNRehab is the Best Clinic in NYC for Golfer's Elbow Rehab

Modern medicine’s reductionist approach to treatment zeroes in on the locus of pain while neglecting to address the integrated interactions of the body’s many tissues and structures. Pain is a symptom, not a condition unto itself, and while pain management may provide temporary relief, it does not resolve the mechanical factors that contribute to tendon pathology.

At NYDNRehab, we treat the whole patient, not just their symptoms. Our holistic and integrated approach considers the many tissues and structures that can contribute to overuse syndromes. Our personalized one-on-one treatment approach is based on your unique patient profile, and not on some cookie-cutter treatment template or timeline.

We use dynamic high resolution ultrasound to visualize the elbow and its associated structures in real time, to identify factors like myofascial trigger points, fascia densifications and adhesions, nerve entrapments, and mechanical issues that overload the tendons at the medial epicondyle.

Our advanced regenerative technologies and cutting-edge therapies accelerate healing, so you can get back to your favorite activities with full pain-free function.

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    Clinical Case Studies
    NYDNRehab


    Case Study: Patient with Elbow Pain Self-Misdiagnoses

    Our Patient Our patient is a 57 year-old barber and recreational bodybuilder complaining of “tennis elbow” that would not go away. The pain worsened while lifting weights at the gym, and he reported pain and stiffness after waking up in the morning. He had previously had physical therapy, and an orthopedist had blindly injected a […]

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    Golfer's Elbow FAQs

    What is the difference between golfer's elbow and tennis elbow?
    Simply put, tennis elbow (lateral epicondylitis) symptoms appear at the end of the outer elbow, affecting the muscles and tendons you use to bend your wrist backward and straighten your fingers. By contrast, golfer’s elbow (medial epicondylitis) symptoms arise at the end of the inner elbow, affecting the muscles and tendons you use to flex your wrist forward and close your fingers into a fist.
    Will my golfer's elbow symptoms go away on their own?
    If proper care is taken to treat your symptoms and avoid activities that cause medial epicondylitis, it will most likely self-resolve over time. Rest, ice, and compression can help speed recovery. However, symptoms can persist for months, especially if you continue to play golf or engage in other activities that overload your elbow. Treatment with regenerative therapies can accelerate tissue healing and dramatically shorten your recovery time.
    I've had golfer's elbow multiple times – what am I doing wrong?
    Recurrent bouts of golfer’s elbow are often related to your swing technique. Your grip, wrist motion and total-body stance can all affect your elbow. A 3D motion analysis can help you identify and correct faulty motor mechanics that are overloading your elbow – it can even improve your golf game!
    Once I begin treatment, how long will it take for my golfer's elbow to stop hurting?
    It all depends on your unique condition and the type of therapy you receive. At NYDNRehab, our diagnostic technologies, regenerative therapies and personalized holistic approach work together to expedite recovery, so you can get back to your favorite activities as quickly as possible.
    I've never played golf in my life – how can I have golfer's elbow?
    Golfer’s elbow can arise from a number of activities that repeatedly overload the tendons, bones, and muscles used for gripping and wrist flexion. Activities that require repetitive gripping and wrist flexion include pitching, rock climbing, racquet sports, and weight training. Some occupations can also put you at risk if your work requires repetitive gripping and flexion.
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    In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

    Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

    The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

    Dynamic ultrasonography examination demonstrating
    the full thickness tear and already occurring muscle atrophy
    due to misdiagnosis and not referring the patient
    to proper diagnostic workup

    Demonstration of how very small muscle defect is made and revealed
    to be a complete tear with muscle contraction
    under diagnostic sonography (not possible with MRI)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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