Introduction Description a contusion of the thigh due to direct trauma Epidemiology demographics 2:1 male: female ratio athletes football, soccer, rugby most common sports more common during competition than practice Pathophysiology mechanism of injury a direct blow to thigh compressing the anterior thigh musculature into the femur pathophysiology small muscle fiber tears lead to hemorrhage and swelling into the anterior compartment myonecrosis and hematoma forms followed by scar formation then muscle regeneration Prognosis self-limited course with a prolonged disability without appropriate treatment initiation of treatment greatly expedites recovery and return to sport (13 days for mild contusions) time to return directly correlated with initial severity of injury Anatomy Muscles anterior compartment sartorius rectus femoris vastus laterals vastus medialis vastus intermedius medial compartment gracillis adductor magnus adductor longus adductor brevis posterior compartment biceps femoris semitendinosus semimembranosus Classification Jackson and Feagin Classification Mild >90 degrees ROM Moderate 45-90 degrees ROM Severe <45 degrees Presentation History collision or direct blow to the thigh during competition Symptoms pain worsening severity over the first 24-48 hours worse with dynamic movements and with knee flexion Physical exam inspection swelling, ecchymosis, point tenderness compare thigh firmness and circumference to contralateral side possible palpable defect indicating partial or complete muscle tear possible knee effusion motion variable loss of knee flexion antalgic gait provocative tests straight leg raise to test integrity of extensor mechanism neurovascular distal neurovascular exam to evaluate for thigh compartment syndrome Imaging Radiographs indications only necessary acutely in severe injuries with high suspicion for underlying fracture findings myositis ossificans occasionally seen in chronic cases MRI indications concern for extensor mechanism disruption best to demonstrate the degree of soft tissue involvement and extensor mechanism integrity finding will find edema with muscles Differential Maintain suspicion for compartment syndrome in severe injuries Treatment Nonoperative immobilization, cryotherapy, NSAIDs, physical therapy indications first line of treatment for acute injuries begin immediately to minimize hematoma formation Operative thigh fasciotomy indications compartment syndrome Techniques Immobilization, cryotherapy, NSAIDs, physical therapy immobilization in 120 degrees of flexion using an ace wrap or hinged knee brace immediately after injury for 24-48 hours, frequent use of cold therapy physical therapy transition to stretching and active ROM exercises after initial flexion period, protected weight-bearing with crutches often required begin functional rehabilitation and sport-specific activities once full and pain-free ROM achieved Thigh fasciotomies approach single anterolateral incision over length of thigh allows access to anterior and posterior compartments decompression incise fascia lata to expose and decompress anterior compartment retract vastus lateralis medially to expose lateral intermuscular septum incise lateral intermuscular septum to decompress posterior compartment may add medial incision to decompress adductor compartment if involved Complications Myositis Ossificans incidence ranges from 9-18% more common with severe contusions develops 2-4 weeks following injury lesions followed with serial imaging, characteristic “egg-shell” calcifications on radiographs treatment observation often successful resection if continued pain with loss of strength and knee motion only operate on mature lesions showing no signs of continued growth maturation occurs around 6-12mos Compartment syndrome usually due to rupture of deep perforating branches of the deep femoral vessels treatment thigh fasciotomy
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Review Topic QID: 3060 1 Iliac crest contusion 1% (7/1058) 2 Avulsion fracture of the lesser trochanter 1% (11/1058) 3 Quadriceps contusion 70% (741/1058) 4 Hamstring rupture 28% (297/1058) 5 Sports Hernia 0% (0/1058) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
QUADRICEPS HAEMATOMA (C2657) Knee & Sports - Quadriceps Contusion HPI - Direct injury right thigh while playing handball 02 weeks back. Was able to continue with the game. Developed pain right thigh along with painful restriction of knee flexion. No fever. Likely diagnosis? 8/19/2016 273 3 6 Quadriceps Rupture (C2503) Knee & Sports - Quadriceps Contusion HPI - Patient 36 yo, male. 4 months ago ACL anatomic ligamentoplasty and partial meniscectomy of lateral meniscus. Due to knee stiffness, 2 manipulations under anesthesia were necessary. Do you think this is a complete rupture or a partial rupture? 2/10/2016 418 4 5