title: Sequential bilateral complete rupture of the rectus femoris muscle in a patient with hereditary spastic paraplegia.
abstract: BACKGROUND
  This case raises questions about the pathophysiology of muscle ruptures in highly functional patients with hereditary spastic paraplegia (HSP) who have only minor spasticity and no significant muscle shortening. Literature on the skeletal muscle changes secondary to spasticity or to the underlying disease, HSP, has been explored and compared with this clinical case. Two theoretical hypotheses are discussed. Firstly, chronic spasticity might be a risk factor for histopathological muscle alterations. Secondly, altered protein synthesis due to the underlying genetic mutation may play a role in the mechanical integrity of muscle tissue.
  
  
  METHODS
  This is the first case report of a sequential bilateral complete disruption of the rectus femoris muscle after minimal trauma, in a 55-year-old man with HSP. Pain was the main complaint, without significant increase in spasticity. Walking ability was not significantly impaired. Conservative treatment resulted in resolution of the complaints.
  
  
  CONCLUSIONS
  This unique case of a bilateral complete rectus femoris muscle rupture after minimal trauma in a patient with HSP presenting with minor spasticity raises questions on the pathophysiology of the skeletal muscle changes in HSP patients and more generally in spastic patients.
authors.affiliation: Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium - lizeraes@hotmail.com.
authors.forename: Lize
authors.initials: L
authors.lastname: Raes
authors.affiliation: Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Draulans
authors.affiliation: Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: van Campenhout
authors.affiliation: Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Ortibus
authors.affiliation: Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Peers
authors.affiliation: Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Carlotte
authors.initials: C
authors.lastname: Kiekens
mesh_terms: D000072700:Conservative Treatment / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D052097:Quadriceps Muscle / Q000503:physiopathology*; D035583:Rare Diseases; D018570:Risk Assessment; D012421:Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation*; D015419:Spastic Paraplegia, Hereditary / Q000150:complications / Q000175:diagnosis*; D018608:Ultrasonography, Doppler / Q000379:methods