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Quadriceps Contusion

Topic updated on 05/03/15 4:51pm
Introduction
  •  An injury commonly seen in athletes
    • occurs as a result of direct trauma
    • common in contact sports
Presentation
  • Symptoms
    • pain at anterior thigh
  • Physical exam
    • tenderness at anterior thigh
    • limited active knee flexion due to pain
    • possible knee effusion
    • peform straight leg raise to ensure extensor mechanism is intact
    • test sensory branches of femoral nerve (lateral, intermediate, and medial cutaneous nerves) during evaluation for compartment syndrome
Imaging
  • Radiographs
    • imaging not necessary if mild contusion and extensor mechanism intact
    • plain radiograph to evaluate for myositis ossificans in chronic injuries
  • MRI
    • has the highest sensitivity and specificity for disorders of the quadriceps
    • MRI helpful in moderate to severe contusions or if quadriceps tendon competency in doubt
Treatment
  • Nonoperative
    • immobilize in 120 degrees of knee flexion for 24 hours followed by therapy  
      • indications
        • acute injuries
      • technique
        • acute phase
          • cold therapy
          • ACE bandage or hinged knee brace  
        • subacute phase
          • begin active pain-free quadriceps stretching several times a day thereafter
          • weight bearing as tolerated with use of crutches often needed initially
          • close monitoring for compartment syndrome
    • Angiotensin II receptor blockade (e.g. Losartan) 
      • indications
        • increase muscle regeneration after contusion
        • decrease fibrosis
      • mecahnism
        • blockade of insulin-like growth factor
        • reduces apoptotic cascade of muscle
  • Operative
    • thigh fasciotomies
      • indications
        • compartment syndrome present
Complications
  • Compartment syndrome
    • usually rupture of deep perforating branches of the vastus intermedius
  • Myositits ossificans
    • incidence of 5-9% rate with quadriceps contusion

 

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Qbank (2 Questions)

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(OBQ09.247) A 20 year-old Division 1 football player is injured in practice. His treatment regimen includes immobilization of the knee in 120 degrees of flexion. What injury has this patient most likely sustained? Topic Review Topic

1. Iliac crest contusion
2. Avulsion fracture of the lesser trochanter
3. Quadriceps contusion
4. Hamstring rupture
5. Sports Hernia

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