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
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% (7/1032) 2 Avulsion fracture of the lesser trochanter 1% (10/1032) 3 Quadriceps contusion 69% (717/1032) 4 Hamstring rupture 29% (296/1032) 5 Sports Hernia 0% (1/1032) 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 270 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 415 4 5