Quadriceps Muscle Contusion

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Clinically Relevant Anatomy

The Quadriceps femoris is a hip flexor and a knee extender. This muscle is composed of 4 subcomponents:
-M. Rectus femoris
-M. Vastus medialis
-M. Vastus lateralis
-M. Vastus intermedius
The rectus femoris originates at the ilium, it is the only muscle that is participating in both functions; flexion of the hip and extension of the knee. The other three parts are only involved in the extension of the knee.
The M. rectus femoris is even the most superficial part of the Quadriceps and it crosses the hip and the knee joints. Innervation of these muscles is by the femoral nerve.

Mechanism of Injury / Pathological Process

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Clinical Presentation

Definition
Charley horse/cork thigh/dead leg
A quadriceps contusion is a traumatic blow, a deep bruise to the anterior lateral or medial aspect of the thigh. If examination confirms an area of swelling and tenderness with terrible pain on passive stretch and active contraction, the diagnosis is a Quadriceps contusion with resultant hematoma. The contusion is the result of an external force that can damage the muscle but can’t eliminate its function completely. Quadriceps contusions can lead to two serious complications: compartment syndrome Compartment Syndrome and myositis ossificans.

Description
A contusion is the most common acute thigh injury in contact sport such as football, rugby and basketball. In sports such as football, cricket, soccer and lacrosse, a ball, helmet or shoulder pad at high speed may cause a contusion. Localised bleeding may increase tissue pressure and tissue damage. The bleeding can be intramuscular or intermuscular. The intramuscular hematoma is more painful and restrictive of range of motion than the intermuscular hematoma.

Diagnostic Procedures

Thigh contusions are graded depending on how far you can bend your knee, your ability to walk, and if you are able to do a deep knee bend as follows:

• Mild : Mild contusions are characterised by a little or no loss of range of motion and minimal loss of strength. There is an intramuscular bruising that produces mild bleeding and swelling, little pain and mild point tenderness along the injury site. The patient may or may not remember the incident and was able to continue the activity. Tenderness to palpation is finding.
>90°C

• Moderate: There is an increase in bleeding into the muscle tissue, a noticeable limp, more bruising and swelling, and an inability to flex the knee past 90 degrees without significant pain. The patient usually remembers the incident but can continue the activity although may stiffen up with rest. Tenderness to palpation is finding.
45°C to 90°C

• Severe: Severe contusions are characterised by a severely antalgic gait, noticeably swollen and tender muscle mass, functional loss of strength and tenderness to palpation over a large area. The patient will be unable to walk properly without the aid of crutches. The patient will remember the incident and was not able to control rapid onset of swelling or bleeding.
<45°C

Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Key Evidence

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Resources

A way of finding information about a Quadriceps contusion is visiting databases such as PubMed and Web of Knowledge and reading books in the library. The keywords or combinations of the keywords that were most successful were: ‘contusion’, ‘quadriceps contusion’, ‘thigh contusion’, ‘quadriceps contusion and treatment’, diagnostic procedure’ and ‘treatment procedure’...

Case Studies

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References

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