Quadriceps Contusions

Diagnosis/Definition

• A quadriceps contusion is a traumatic blow to the anterior (front), lateral (outside) or medial (inside) aspect of the thigh. They are characterized by pain along the injury site, pain during passive range of motion, swelling, discoloration, decreased range of motion, decreased strength and loss of overall function. The extent of a quadriceps contusion is based on a variety of factors, including the amount of force occurring during injury, the degree of muscular relaxation (which determines the depth of the injury) and any previous trauma to the injury site. As a result, patients with a quadriceps contusion will present with varying degrees of severity.
  • Grade I (Mild)
  Consists of superficial intramuscular bruising that produces mild bleeding and swelling, little pain and mild point tenderness along the injury site. There is little or no loss of range of motion. The patient will have active knee range of motion >90°.
  • Grade II (Moderate)
  Consists of a deeper bruise consisting of moderate pain, swelling and discoloration along the injury site. Active knee range of motion is between 45° and 90°. The patient will demonstrate an obvious limping gait, possibly favoring the involved leg.
  • Grade III (Severe)
  Consists of deep intramuscular mass, possibly causing it to bulge outward. Symptoms include severe pain, loss of function, and increased amount of edema and ecchymosis. Active knee range of motion is <45°.

Initial Diagnosis and management

• History and physical examination.
• Plain films if necessary
• Rest and elevation
• Ice and use compression
• Appropriate restrictions of activity.

Ongoing Management and Objective

• Rest is individualized depending upon severity
• Immobilization is contraindicated in minor injuries however crutches should be used if ambulation is painful.
  • Phase I
  Initial treatment of a quadriceps contusion consists of limiting hemorrhage, mainly accomplished by RICE. When applying ice, instruct the patient to keep the knee flexed to facilitate the healing process. For Grades II and III, the patient should be given crutches with the leg wrapped in an ace bandage in a knee-flexed position.
  
  • Phase II
  After the acute phase, the patient can be discharged from the crutches when they demonstrate good quad control and a normalized gait. The patient can then progress to pain-free isometric quadriceps exercises and mild stretching to restore range of motion.
  
  • Phase III
  Return to pain-free functional rehabilitation, including strength, endurance and sport-specific drills.

Indication a profile is needed

• Any limitations that affect strength, range of movement, and efficiency of feet, legs, lower back and pelvic girdle.
• Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent moderate marching, climbing, timed walking, or prolonged effect.
• Defects or impairments that require significant restriction of use.