Quadriceps contusion in Adult
Classic history and presentation:
- History of direct trauma to the thigh.
- Pain gets worse in the first 24-48 hours after trauma.
- Unable to bear weight on injured limb.
- Limited, painful knee range of motion (ROM).
- Swelling, point of tenderness, and ecchymosis / bruising seen in the anterior compartment of the thigh.
- Gait will range from normal to antalgic depending on injury severity.
Quadriceps contusion is twice as common in male patients compared to female patients.
Risk factors: Quadriceps contusion risk factors are participation in contact sports, high level of competition, lack of protective equipment use, athletic experience, and playing position. The most common sports associated with quadriceps contusion are football, soccer, and rugby.
Pathophysiology: This is caused by direct trauma to the anterior compartment of the thigh and compressing musculature into the femur. This injury causes muscle fiber tears, which forms a hematoma within the muscle, causing pain, swelling, and loss of motion.
Grade / classification system:
Jackson and Feagin classification –
- Grade 1: Mild, > 90 degrees ROM for knee flexion, patient is able to bend knee, normal gait.
- Grade 2: Moderate, 45-90 degrees ROM for knee flexion, patient is unable to bend knee or raise from chair, antalgic gait.
- Grade 3: Severe, < 45 degrees ROM for knee flexion, patient is unable to ambulate or bear weight on injured leg, effusion around the knee, antalgic gait.
S70.10XA – Contusion of unspecified thigh, initial encounter
84416003 – Contusion of thigh
- Femoral shaft fracture
- Femoral stress fracture
- Compartment syndrome of the anterior thigh
- Femoral nerve injury
- Patellar stress fracture
- Lumbar radiculopathy
- Meralgia paresthetica
- Hip fracture
- Hip dislocation
- Deep vein thrombosis
- Distal femoral fracture
- Distal femoral physeal fracture
- Hamstring strain
- Proximal hamstring rupture / tear