A 7-year-old boy presented with abnormal gait since age 3 years. Examination showed left-sided limping with external rotation. On passive flexion of the knees while the patient lied prone, the left heel could not reach the buttock and the left hip rose up (Video 1). This indicated a positive Ely test indicating limited flexibility of the rectus femoris muscle.1 Neurological examination was otherwise unremarkable. He had normal skeletal x-rays of both legs. MRI showed fibrosis of the rectus femoris muscle (Figure), which may be idiopathic or related to trauma. The patient had no history of muscle injury thus distant intramuscular injection was suspected to be the cause. Early diagnosis helps improve mobility through early surgical intervention.2 Ely test, which is not routinely performed during neurological examination, might be helpful in evaluating children with abnormal gait.

Figure MRI Showing Fibrosis of the Left Rectus Femoris Muscle

T1-weighted MRI of bilateral thighs showing moderate and diffuse reduced muscle bulk of the left rectus femoris with some distal fat replacement but no obvious acute change, edema, or strain. The rest of the quadriceps appear unremarkable.

Author Contributions

F. Al-Maadid: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; analysis or interpretation of data. F. Hadid: major role in the acquisition of data. A. Mohamedzain: major role in the acquisition of data; additional contributions (in addition to 1 or more of the above criteria). F. Ali: major role in the acquisition of data. F. Thabet: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data.

Study Funding

The authors report no targeted funding.

Disclosure

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Footnotes

Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Submitted and externally peer reviewed. The handling editor was Resident & Fellow Section Deputy Editor Ariel Lyons-Warren, MD, PhD.

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Received April 4, 2023.Accepted in final form September 6, 2023.© 2023 American Academy of Neurology