Quad Contusion

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Soccer Player with possible quad contusion injury on the right thigh.

A quad contusion (or quadriceps contusion) is a contusion injury to the quadricep muscles at the front of the thigh. This injury occurs when the thigh sustains a direct blow that crushes those muscles against the thigh bone.

Typically, despite the damage to the muscle, its function is not usually completely lost. If the contusion leads to bleeding into the surrounding tissue (haematoma), then swelling and tenderness will be present together with severe pain on passive stretching and active contraction.

A quad contusion is usually a sports related injury and can be very painful. A sometimes used colloquial name for this injury is a “charley”.

Types & Causes Of Quad Contusion Injuries

Types Of Quad Contusion

‘There are 2 types of quad contusion injury:

  • An intramuscular contusion (when the muscle fibers tear inside the sheath containing the muscle); or
  • An inter-muscular contusion, with tearing of both muscle and sheath.

Of these two types, the intramuscular injury results in more pain and loss of range of motion of the thigh. However, both types of injury can result in localized bleeding and tissue damage in the quadriceps area

Causes

This type of injury is common in sports that involve a lot of direct contact between athletes (e.g. football, rugby, basketball and hockey) or collisions with fixtures on or around the playing field  (e.g. soccer or lacrosse). In fact, it is the most common acute thigh injury in contact sports such as these.

A common event that leads to quadricep muscle contusion injuries is when one player’s knee strikes the quadricep muscles of another player. This can happen, for example,  during a collision between them.

It can also happen if the patient’s thigh directly strikes an object while he or she is falling, such as in skiing or snowboarding.

Symptoms

The symptoms of quad contusions are usually relatively severe. This is because the quadricep muscles that are most vulnerable to a blow are lying against a large bone (the femur) . They have little or no room for movement to absorb a powerful blow from the front.

Most of the symptoms are caused by rupture of the muscle fibres. Initially, only negligible symptoms are present. However, after 24 hours, haematoma formation within the muscle causes pain, swelling, stiffness and functional impairment of the quadriceps muscle.

Doctors classify quad contusion injuries into three categories. These are first, second and third degree, going from least to most severe.

The descriptions of each category, and the associated symptoms, are as follows:

  • First degree contusion – little or no pain, mild swelling at most and mild muscle tenderness;
  • Second degree contusion – moderate pain and swelling in the injured area and some difficulty in knee flexion. Bending the knee to 90 degrees can only be achieved with difficulty;
  • Third degree contusion – severe pain, swelling and tenderness. In addition there is usually significant restriction of knee range of motion. The patient will find it almost impossible to flex the hip or bend the knee. This, in turn, can lead to difficulty walking.

Individuals experiencing some or all of these symptoms after a blow to the front of the thigh may be suffering a quad contusion. The next step should be to call a doctor (preferably one with sports medicine experience) and make an appointment for an examination and possible diagnosis.

Quad contusions, if left untreated, can sometimes develop into more severe injuries. One of these is myositis ossificans. This is a condition in which bone tissue forms inside the muscle.

Another possible complication is compartment syndrome. This is a condition whereby a critical increase in the pressure within a confined compartmental space leads to a fall in the perfusion pressure to the tissue within that compartment.

Hence, individuals who think they have experienced a quad contusion should seek medical help without delay.

Treatment Of A Quad Contusion Injury

With rest and the correct treatment, most quadriceps contusions heal spontaneously within a few weeks.

To treat a quad contusion, most doctors will suggest the following:

  • Rest your quadricep muscles by temporarily refraining from activity that may stress them and aggravate the injury;
  • As part of resting the quadricep muscles, the patient should consider using crutches to keep his or her weight off the thigh. This is especially important for second or third degree quad contusion injuries.
  • Apply ice to the quadriceps area for about 20 minutes at a time and at intervals of 2-3 hours. Alternatively, use a cold compress instead of ice.This may be more convenient if the patient is away from a refrigerator and ice is not readily available. Be careful to use a towel or other covering to insulate the naked skin from prolonged contact with the ice or cold compress;
  • If hemorrhaging (internal muscle bleeding) is present, it may be beneficial to perform isometric (muscle contraction) exercises while applying ice.
  • An elastic wrap can help to support the quadriceps and reduce swelling
  • On returning to sports action once he or she is pain free, the patient should consider wearing a thigh compression sleeve. This will help to protect the injury and allow it to continue to heal.

Some patients may need pain relief with non-steroidal anti-inflammatory drugs like naproxen and ibuprofen as well as with paracetamol. Patients should refrain from applying heat to the contusion, since this can make the swelling worse.

Surgery is only rarely needed and this is reserved for cases which are either very severe or do not get better with conservative treatment.

Prevention Of Quad Contusion Injuries

As we have mentioned above, this is one of the most common acute thigh injuries in contact sports. It can also be among the most painful. Consequently, it is worthwhile to provide some suggestions on how athletes in particular can try to prevent it in the first place:

  • Following a physical therapy program of exercises to strengthen the thigh muscles and improve their ability to withstand a direct blow;
  • Frequent stretching and flexing of quadricep muscles;
  • Wearing protective gear like thigh pads can be useful in reducing the risk of experiencing this injury. This is already a common practice among batsmen in cricket. They wear thigh pads in order to protect themselves from injury resulting from a blow to the quadriceps from the ball.

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