Updated: 10/6/2016

Quadriceps Contusion

Topic
Review Topic
0
0
Questions
4
0
0
Evidence
5
0
0
Cases
2
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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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Questions (4)
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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? 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

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ARTICLES (9)
CASES (2)
Topic COMMENTS (1)
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