Quadriceps Muscle Strain: Difference between revisions
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'''Original Editors ''' - [[User:Maxime Tuerlinckx|Maxime Tuerlinckx]] | '''Original Editors ''' - [[User:Maxime Tuerlinckx|Maxime Tuerlinckx]] | ||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} </div> | ||
== Search Strategy == | == Search Strategy == | ||
Databases: Pubmed, PeDro, eMedicine, Medscape | Databases: Pubmed, PeDro, eMedicine, Medscape | ||
Keywords: quadriceps muscle strain, muscle strain, strain injuries, strain injuries treatment, rectus femoris strain injury,... | Keywords: quadriceps muscle strain, muscle strain, strain injuries, strain injuries treatment, rectus femoris strain injury,... | ||
== Definition/Description == | == Definition/Description == | ||
A quadriceps muscle strain is an acute tearing injury of the quadriceps. This injury is usually due to an acute stretch of the muscle often at the same time of a forceful contraction or repetitive functional overloading. The quadriceps which consists of four parts, can be overloaded by repeated eccentric muscle contractions of the knee extensor mechanism.<ref name="5">Joel M. Kary. Diagnosis and management of quadriceps strains and contusions. Curr rev Musculoskeletal Med. 2010 (B)</ref> When the muscle is elongated by an eccentric contraction, high muscle forces are generated during the elongation and added to the forces produced by the passive connective tissue so it almost certainly induces a muscle strain injury. This force is several times higher than the force produced during a maximal isometric contraction'''.<ref name="1">Thomas M De Bernardino, MD; Leslie Milne, MD, Quadriceps injury, 2010, medscape (A)</ref><ref name="3">Elizabeth Quinn. Quadriceps muscle group- Quad injuries, pulls and strains: Diagnosis, treatment and prevention of quad injuries, pulls and strains. About.com guide. 2010</ref>''' | A quadriceps muscle strain is an acute tearing injury of the quadriceps. This injury is usually due to an acute stretch of the muscle often at the same time of a forceful contraction or repetitive functional overloading. The quadriceps which consists of four parts, can be overloaded by repeated eccentric muscle contractions of the knee extensor mechanism.<ref name="5">Joel M. Kary. Diagnosis and management of quadriceps strains and contusions. Curr rev Musculoskeletal Med. 2010 (B)</ref> When the muscle is elongated by an eccentric contraction, high muscle forces are generated during the elongation and added to the forces produced by the passive connective tissue so it almost certainly induces a muscle strain injury. This force is several times higher than the force produced during a maximal isometric contraction'''.<ref name="1">Thomas M De Bernardino, MD; Leslie Milne, MD, Quadriceps injury, 2010, medscape (A)</ref><ref name="3">Elizabeth Quinn. Quadriceps muscle group- Quad injuries, pulls and strains: Diagnosis, treatment and prevention of quad injuries, pulls and strains. About.com guide. 2010</ref>''' | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
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The quadriceps femoris acts as a hip flexor and knee extender. This muscle is composed of 4 subcomponents:<br>'''-M. Rectus femoris <br>-M. Vastus medialis <br>-M. Vastus lateralis <br>-M. Vastus intermedius''' | The quadriceps femoris acts as a hip flexor and knee extender. This muscle is composed of 4 subcomponents:<br>'''-M. Rectus femoris <br>-M. Vastus medialis <br>-M. Vastus lateralis <br>-M. Vastus intermedius''' | ||
The M. Rectus femoris is the only part of the muscle participating in both flexion of the hip and extension of the knee. The other 3 parts are only involved in the extension of the knee. The M. rectus femoris is the most superficial part of the quadriceps and it crosses both the hip and knee joints. So it is more susceptible to stretch-induced strain injuries. <ref name="1" /> The most common sites of strains are the muscle tendon junction just above the knee (both distal and proximal but most frequently at the distal muscle-tendon) and in the muscle itself.<ref name="3" />'''<br>''' | The M. Rectus femoris is the only part of the muscle participating in both flexion of the hip and extension of the knee. The other 3 parts are only involved in the extension of the knee. The M. rectus femoris is the most superficial part of the quadriceps and it crosses both the hip and knee joints. So it is more susceptible to stretch-induced strain injuries. <ref name="1" /> The most common sites of strains are the muscle tendon junction just above the knee (both distal and proximal but most frequently at the distal muscle-tendon) and in the muscle itself.<ref name="3" />'''<br>''' | ||
== Mechanism of injury == | == Mechanism of injury == | ||
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There are generally three mechanisms for quadriceps strain. <br>'''(1)''' Sudden deceleration of the leg (kicking),<br>'''(2)''' violent contraction of the quadriceps (sprinting) and <br>'''(3)''' rapid deceleration of an overstretched muscle (by quickly change of direction). | There are generally three mechanisms for quadriceps strain. <br>'''(1)''' Sudden deceleration of the leg (kicking),<br>'''(2)''' violent contraction of the quadriceps (sprinting) and <br>'''(3)''' rapid deceleration of an overstretched muscle (by quickly change of direction). | ||
The most commonly strained quadriceps muscle is the M. Rectus Femoris, because he crosses two joints and has a high proportion of type 2 fibers. '''[8,9]<br>''' | The most commonly strained quadriceps muscle is the M. Rectus Femoris, because he crosses two joints and has a high proportion of type 2 fibers. '''[8,9]<br>''' | ||
== Risk Factors == | == Risk Factors == | ||
The strongest risk factor for developing a quadriceps muscle strain injury is a recent history of muscle strains. The next strongest risk factor in line is a past history of a quadriceps muscle strain. Other risk factors for this injury may include low muscle strength, an imbalance between the quadriceps and the hamstrings, limited flexibility, muscle fatigue, a poor technique, and so on. Another possible cause of strain injury can be a bad warming-up before an exercise or no warming-up at all'''.<ref name="6">Konstantinos Fousekis et al., Intrinsic risk factors of non-contact quadriceps and hamstring strains in soccer: a prospective study of 100 professional players, Br J Sports Med 2011;45:709-714 (B)</ref>''' | The strongest risk factor for developing a quadriceps muscle strain injury is a recent history of muscle strains. The next strongest risk factor in line is a past history of a quadriceps muscle strain. Other risk factors for this injury may include low muscle strength, an imbalance between the quadriceps and the hamstrings, limited flexibility, muscle fatigue, a poor technique, and so on. Another possible cause of strain injury can be a bad warming-up before an exercise or no warming-up at all'''.<ref name="6">Konstantinos Fousekis et al., Intrinsic risk factors of non-contact quadriceps and hamstring strains in soccer: a prospective study of 100 professional players, Br J Sports Med 2011;45:709-714 (B)</ref>''' | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
See [[ | See [[Muscle Strain]] to have an idea of the clinical presentation of this injury. | ||
== Differential Diagnosis == | == Differential Diagnosis == | ||
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add text here | add text here | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
The diagnosis of a quadriceps muscle strain can be compared to the diagnosis of a common muscle strain, see [[Muscle Injuries|Muscle_Injuries]] | The diagnosis of a quadriceps muscle strain can be compared to the diagnosis of a common muscle strain, see [[Muscle Injuries|Muscle_Injuries]] | ||
== Outcome Measures == | == Outcome Measures == | ||
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add text here <br> | add text here <br> | ||
== Physical Therapy Management <br> == | == Physical Therapy Management <br> == | ||
When a quadriceps muscle strain occurs during a competition or training, it is important to react immediately. In the 10 minutes following the trauma one needs to put the knee of the affected leg immediately in 120° of flexion'''.<ref name="1" /><ref name="2">Michael A Herbenick, MD; Michael S Omori, MD; Paul Fenton, MD. Contusions, 2009 (A)</ref> '''This avoids potential muscle spasms, reduces the hemorrhage and minimizes the risk of developing myositis ossificans<ref name="2" />'''<br>'''If the knee is left in extension the healing process will be slower and more painful because the quadriceps will start to heal in a shortened position.<ref name="2" /><ref name="3" /> The rest of the therapy during the healing process is based on the [[RICE Therapy|RICE therapy.]] This includes: <br>'''R'''est, <br>'''I'''ce treatment for 20 minutes every 2-3 hours, <br>'''C'''ompression with an ACE bandage<br>'''E'''levation'''.<ref name="2" /><ref name="4" />''' | When a quadriceps muscle strain occurs during a competition or training, it is important to react immediately. In the 10 minutes following the trauma one needs to put the knee of the affected leg immediately in 120° of flexion'''.<ref name="1" /><ref name="2">Michael A Herbenick, MD; Michael S Omori, MD; Paul Fenton, MD. Contusions, 2009 (A)</ref> '''This avoids potential muscle spasms, reduces the hemorrhage and minimizes the risk of developing myositis ossificans<ref name="2" />'''<br>'''If the knee is left in extension the healing process will be slower and more painful because the quadriceps will start to heal in a shortened position.<ref name="2" /><ref name="3" /> The rest of the therapy during the healing process is based on the [[RICE Therapy|RICE therapy.]] This includes: <br>'''R'''est, <br>'''I'''ce treatment for 20 minutes every 2-3 hours, <br>'''C'''ompression with an ACE bandage<br>'''E'''levation'''.<ref name="2" /><ref name="4" />''' | ||
This hasn’t been proved in scientific literature, but it is commonly used by physiotherapists and doctors. Before a patient turn back to normal activities, he or she should do some exercises and stretching to reinforce the quadriceps and hamstrings- muscle. The exercises can be isometric, isotonic, isokinetic and in a later stage of the revalidation sport- or ADL-specific'''.<ref name="1" />'''<br>An overview of the types of exercises:<br>-isometric: muscle contraction without change in muscle length (mostly against a fixed object). <br>-isotonic: muscle contraction against a constant resistance with a shortening/lengthening of the muscle. <br>-isokinetic: muscle contraction by a specific movement (e.g. flexion-extension of the knee). | This hasn’t been proved in scientific literature, but it is commonly used by physiotherapists and doctors. Before a patient turn back to normal activities, he or she should do some exercises and stretching to reinforce the quadriceps and hamstrings- muscle. The exercises can be isometric, isotonic, isokinetic and in a later stage of the revalidation sport- or ADL-specific'''.<ref name="1" />'''<br>An overview of the types of exercises:<br>-isometric: muscle contraction without change in muscle length (mostly against a fixed object). <br>-isotonic: muscle contraction against a constant resistance with a shortening/lengthening of the muscle. <br>-isokinetic: muscle contraction by a specific movement (e.g. flexion-extension of the knee). | ||
All of these exercises should be done in a range of motion that is pain-free. These strengthening exercises will also help in preventing from a new strain injury.<ref name="1" /> | All of these exercises should be done in a range of motion that is pain-free. These strengthening exercises will also help in preventing from a new strain injury.<ref name="1" /> | ||
== Key Research == | == Key Research == | ||
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add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | ||
== Resources <br> == | == Resources <br> == | ||
== Clinical Bottom Line == | == Clinical Bottom Line == | ||
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== References == | == References == | ||
10. Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.<br>11. Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams & Wilkins, 656p.<br> | 10. Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.<br>11. Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams & Wilkins, 656p.<br> | ||
<references /> | <references /> | ||
[[Category:Vrije_Universiteit_Brussel_Project|Template:VUB]] | [[Category:Vrije_Universiteit_Brussel_Project|Template:VUB]] | ||
Revision as of 16:43, 8 April 2014
Original Editors - Maxime Tuerlinckx
Top Contributors - Mandeepa Kumawat, Maxime Tuerlinckx, Carlos Areia, Lucinda hampton, Shanna Blyckaerts, Admin, Shaimaa Eldib, Kim Jackson, Wanda van Niekerk, Jelle Van Hemelryck, Rachael Lowe, Frederik Töpke, WikiSysop, Joao Costa, Claire Knott, Fasuba Ayobami, 127.0.0.1, Rucha Gadgil, Evan Thomas, Scott Buxton, Naomi O'Reilly and Daphne Jackson </div>
Search Strategy[edit | edit source]
Databases: Pubmed, PeDro, eMedicine, Medscape
Keywords: quadriceps muscle strain, muscle strain, strain injuries, strain injuries treatment, rectus femoris strain injury,...
Definition/Description[edit | edit source]
A quadriceps muscle strain is an acute tearing injury of the quadriceps. This injury is usually due to an acute stretch of the muscle often at the same time of a forceful contraction or repetitive functional overloading. The quadriceps which consists of four parts, can be overloaded by repeated eccentric muscle contractions of the knee extensor mechanism.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title When the muscle is elongated by an eccentric contraction, high muscle forces are generated during the elongation and added to the forces produced by the passive connective tissue so it almost certainly induces a muscle strain injury. This force is several times higher than the force produced during a maximal isometric contraction.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Clinically Relevant Anatomy[edit | edit source]
The quadriceps femoris acts as a hip flexor and knee extender. This muscle is composed of 4 subcomponents:
-M. Rectus femoris
-M. Vastus medialis
-M. Vastus lateralis
-M. Vastus intermedius
The M. Rectus femoris is the only part of the muscle participating in both flexion of the hip and extension of the knee. The other 3 parts are only involved in the extension of the knee. The M. rectus femoris is the most superficial part of the quadriceps and it crosses both the hip and knee joints. So it is more susceptible to stretch-induced strain injuries. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The most common sites of strains are the muscle tendon junction just above the knee (both distal and proximal but most frequently at the distal muscle-tendon) and in the muscle itself.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Mechanism of injury[edit | edit source]
There are generally three mechanisms for quadriceps strain.
(1) Sudden deceleration of the leg (kicking),
(2) violent contraction of the quadriceps (sprinting) and
(3) rapid deceleration of an overstretched muscle (by quickly change of direction).
The most commonly strained quadriceps muscle is the M. Rectus Femoris, because he crosses two joints and has a high proportion of type 2 fibers. [8,9]
Risk Factors[edit | edit source]
The strongest risk factor for developing a quadriceps muscle strain injury is a recent history of muscle strains. The next strongest risk factor in line is a past history of a quadriceps muscle strain. Other risk factors for this injury may include low muscle strength, an imbalance between the quadriceps and the hamstrings, limited flexibility, muscle fatigue, a poor technique, and so on. Another possible cause of strain injury can be a bad warming-up before an exercise or no warming-up at all.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Characteristics/Clinical Presentation[edit | edit source]
See Muscle Strain to have an idea of the clinical presentation of this injury.
Differential Diagnosis[edit | edit source]
add text here
Diagnostic Procedures[edit | edit source]
The diagnosis of a quadriceps muscle strain can be compared to the diagnosis of a common muscle strain, see Muscle_Injuries
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
When a quadriceps muscle strain occurs during a competition or training, it is important to react immediately. In the 10 minutes following the trauma one needs to put the knee of the affected leg immediately in 120° of flexion.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title This avoids potential muscle spasms, reduces the hemorrhage and minimizes the risk of developing myositis ossificansCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
If the knee is left in extension the healing process will be slower and more painful because the quadriceps will start to heal in a shortened position.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The rest of the therapy during the healing process is based on the RICE therapy. This includes:
Rest,
Ice treatment for 20 minutes every 2-3 hours,
Compression with an ACE bandage
Elevation.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
This hasn’t been proved in scientific literature, but it is commonly used by physiotherapists and doctors. Before a patient turn back to normal activities, he or she should do some exercises and stretching to reinforce the quadriceps and hamstrings- muscle. The exercises can be isometric, isotonic, isokinetic and in a later stage of the revalidation sport- or ADL-specific.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
An overview of the types of exercises:
-isometric: muscle contraction without change in muscle length (mostly against a fixed object).
-isotonic: muscle contraction against a constant resistance with a shortening/lengthening of the muscle.
-isokinetic: muscle contraction by a specific movement (e.g. flexion-extension of the knee).
All of these exercises should be done in a range of motion that is pain-free. These strengthening exercises will also help in preventing from a new strain injury.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
10. Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.
11. Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams & Wilkins, 656p.
