Quadriceps Muscle Contusion

Clinically Relevant Anatomy[edit | edit source]


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. [2]

  

Clinical Presentation[edit | edit source]


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. [1] [5]
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. [1] [6]


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. [4] [5]

Diagnostic Procedures[edit | edit source]

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: [1] [4] [5]


• 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[edit | edit source]

add links to outcome measures here (see Outcome Measures Database)

Management / Interventions
[edit | edit source]

Mild and moderate


The purpose of treatment in Phase I is to minimize hemorrhage. The first 24 hours following the injury is the most important period in the treatment of a Quadriceps contusion. The earlier the treatment, the better the results. [5] The treatment is based on the RICE principle (rest, apply ice and compression and elevate the affected area). Ice the thigh with an elastic bandage or brace for twenty minutes and keep the hip and knee in flexion as far as comfortable. 

This position increases counterpressure inside the injured muscle and contributes to hemostatis. Furthermore, it will help minimise range of motion loss and muscle bleeding. After twenty minutes of icing, wait at least forty minutes and repeat. [1]
The reason of this aggressive treatment is to minimise the risk of developing myositis ossificans. If the knee is left in extension, the quadriceps starts to heal in a shortened position and the patient experiences a more painful and slower return to full flexion capacity.[3] The athlete can use crutches to ensure adequate rest if full weight-bearing is painful. If the leg continues to swell, consideration should be given to the possibility of a developing compartment syndrome or continued hemorrhage. [5]


The physiotherapist can start giving ultrasound, electrical stimulation, stretching and sport massage techniques. The massage techniques are useful to facilitate the removal of swelling and bruising but is not recommended for 48 hours following contusion. The athlete must be careful not to overstretch! Stretching should be pain free. Gradually build up the weight to strengthen the quadriceps. When the athlete gets back the full strength, motion and endurance of the quadriceps, he may be able to return to sports. [4] [5]

The most of the rehabilitation programs are based on the tissue’s theoretical healing response.

Differential Diagnosis
[edit | edit source]

add text here relating to the differential diagnosis of this condition

 

Resources
[edit | edit source]

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’...

 

References[edit | edit source]

Internet: (pubmed; Web of knowledge, Pedro)

[1] Joel M. Kary, Diagnosis and management of quadriceps strains and contusions, 2010
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941577/?tool=pubmed
Level of evidence: 2A
[2] Andrew C. Waligora, Norman A. Johanson Bruce Elliot Hirsch. Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772911/?tool=pubmed
Level of evidence: 2A

[3] Aronen JG, Garrick JG, Chronister RD, McDevitt ER. Quadriceps contusions: clinical results of immediate immobilization in 120 degrees of knee flexion.
http://www.ncbi.nlm.nih.gov/pubmed/17016112
Level of Evidence: 2B


Library (Jette):

[4] Reid, D.C., 1992. Sports injury assessment and rehabilitation. USA: Churchill Livingstone Inc. Pp. 574-587.

[5] Brukner P. and Khan K., 2006. Clinical sports medicine. 3rd ed. North Ryde NSW: McGraw-Hill Australia Pty Ltd. Pp. 430-434.

[6] Roald Bahr, Sverre Maehlum,2004. Clinical guide to sports injuries. Human Kinetics Pp. 100-103