Quadriceps Contusion

This is the result of sustaining a direct blow to the front of the thigh, resulting in tissue damage and a subsequent hematoma (or bleed). It is more commonly referred to as a ‘Corked Thigh’.

Trauma causes damage to the muscle cells, fascia and blood vessels. It is important that it is managed well as this injury can sometimes progress to “myositis ossificans” or post-traumatic ossification (a painful condition in which bone grows in the muscle belly).

Clinical Features

Depending on the degree of damage pain can range from mild symptoms which don’t restrict activity to severe, making walking on the leg impossible. There is often swelling through the thigh and sometimes bruising.

Diagnosis

The diagnosis is usually made through history and clinical assessment. Investigations such as x-ray are only required to assess for other injury e.g. fracture or myositis ossificans

Treatment

Non-operative conservative management would usually involve the following:

Stage 1

ACUTE INFLAMMATORY NECROTIC PHASE Day 0-3

Immobilisation, ice and rest helps control initial bleeding and inflammatory response, protects from further mechanical insult 1 session is required for acute care. A second follow up session if imaging is required or DVT risk

Management – Complete rest, non weight bearing if possible, boot?, Strapping,ice, compression, immobilise muscle in pain free lengthened position if possible. Adjust pain free lengthened position day 2.

Stage 2

LATE PART OF INFLAMMATORY PHASE BEGINNING OF PROLIFERATIVE PHASE

Day 4

Early mobiisation promotes more capillary ingrowth as well as better muscle fibre orientation

2 – 3 supervised sessions are required to teach exercises, ensure that volume is appropriate and technique is correct. Some support tape may be required.

Management – Teach pain free stretch, exercises to maintain fitness, including upper body and core strength program, massage to uninvolved part of muscle, strapping , unassisted ambulation if pain free, stretching yo injured muscles