Quadriceps Contusion

Definition:

A quad contusion is the result of a direct blow to the anterior thigh. This is a common athletic injury among players of football, basketball, soccer, or any contact sport. It may present with immediate sharp pain and loss of function; however, often the pain does not fully develop until several hours later, when the muscle are no longer warmed up.

Anatomy:

The quadriceps muscle group is made up of four large muscles of the anterior thigh: the rectus femoris, the vastus medialis, the vastus lateralis, and the vastus intermedius. The rectus femoris is a long muscle that originates at the hip joint, and the remaining muscles originate at the femur bone. The quadriceps muscles act to extend (straighten) the knee. They are primarily active when a person is kicking, jumping, or running.

Exam:

Your physician will feel your anterior thigh along the length of the injured muscles to locate the area of maximum tenderness, to feel for any defects, and to test the strength of the quadriceps muscles by extension against resistance.

Imaging:

Imaging is usually not necessary, but sometimes radiography is used to rule out a concomitant bone fracture. Ultrasound can be used to look for bleeding or hematoma or to evaluate torn tendons and muscles. Magnetic resonance imaging provides a detailed look at the thigh musculature when a precise characterization of the injury is necessary.

Symptoms:

- A history of a blow to the front of the thigh

- Weakness and pain in the anterior thigh

- Tightness and swelling

- The inability to bend the knee

- Bruising (this may not develop until 24 hours after injury)

- A hematoma (i.e., a collection of blood) that can be felt inside the muscle

Classification:

Mild: active knee flexion of >90°, normal gait, and mild pain

Moderate: active knee flexion of 45° to 90°, mild limp, and moderate pain

Severe: active knee flexion of <45°, severe limp, and extreme pain

Initial Treatment (immediately after the injury):

- Apply an ice pack while lightly stretching the muscle for 20 minutes; repeat this process every 2 hours for 48 to 72 hours.

- Use an elastic compression wrap or a brace to maintain the leg in a flexed position.

- Use crutches if walking is painful or if a limp is present.

- Maintain complete rest for 3 days.

- Avoid heat, massage, or aggressive stretching.

Follow-up Treatment (for 3 to 7 days after the injury)

- Perform quadriceps stretches 2 to 3 times per day.

- Slowly reintroduce light activity (e.g., swimming, walking) as long as it does not cause pain.

- Ice the quadriceps area after exercise.

Return to Sports:

The athlete must be free of pain and attain 120° of knee flexion with the hip extended. Protective thigh padding is recommended when the athlete resumes his or her participation in sports to prevent recurrence.

Prognosis:

The average time of disability is 13 days for mild contusion, 19 days for moderate contusion, and 21 days for severe contusion. A complication associated with severe contusion is called myositis ossificans, which is a calcification of the injured muscle. This condition should be suspected if symptoms worsen after 2 to 3 weeks and if there is persistent swelling. Myositis ossificans is diagnosed with the use of radiography. Prompt treatment and complete rest immediately after the injury are crucial to prevent this complication.