Quadriceps Muscle Strain: Difference between revisions
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== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
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 quadriceps femoris acts as a hip flexor and knee extender. This muscle is composed of 4 subcomponents: | The quadriceps femoris acts as a hip flexor and knee extender. This muscle is composed of 4 subcomponents: | ||
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The rectus femoris originates at the ilium, thus crossing both the hip and knee joint along its course. The remaining muscles originate on the femur. These four muscles are innervated by the femoral nerve.<ref name="5" /> | The rectus femoris originates at the ilium, thus crossing both the hip and knee joint along its course. The remaining muscles originate on the femur. These four muscles are innervated by the femoral nerve.<ref name="5" /> | ||
These four muscles come together in the quadriceps tendon and insert to the base of the patella. <br>The true insertion of the quadriceps femoris is into the tibial tubercle, but convention considers it as inserting into the patella through the quadriceps tendon or the suprapatellar tendon. The part distal to the sesamoid bone is known as the patellar ligament (ligamentum patellae), patellar tendon, or infrapatellar tendon.<ref name="waligora">Waligora AC, Johanson NA, Hirsch BE. Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee. Clin Orthop Relat Res. 2009; 467(12): 3297–3306 (2A)</ref><br> | These four muscles come together in the quadriceps tendon and insert to the base of the patella. <br>The true insertion of the quadriceps femoris is into the tibial tubercle, but convention considers it as inserting into the patella through the quadriceps tendon or the suprapatellar tendon. The part distal to the sesamoid bone is known as the patellar ligament (ligamentum patellae), patellar tendon, or infrapatellar tendon.<ref name="waligora">Waligora AC, Johanson NA, Hirsch BE. Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee. Clin Orthop Relat Res. 2009; 467(12): 3297–3306 (2A)</ref><br> | ||
The 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 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 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 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>''' | ||
Muscle functions:<br> -Rectus Femoris: Hip flexion, Knee extension<br>-Vastus Lateralis: Knee extension<br>-Vastus Intermedius: Knee extension<br>-Vastus Medialis: Knee extension<br>-Semitendinosus: Hip extension, Knee flexion<br>-Semimembranosus: Hip extension, Knee flexion<br>-Biceps Femoris: Hip extension, Knee flexion <br> | Muscle functions:<br> -Rectus Femoris: Hip flexion, Knee extension<br>-Vastus Lateralis: Knee extension<br>-Vastus Intermedius: Knee extension<br>-Vastus Medialis: Knee extension<br>-Semitendinosus: Hip extension, Knee flexion<br>-Semimembranosus: Hip extension, Knee flexion<br>-Biceps Femoris: Hip extension, Knee flexion <br> | ||
[[Image: | [[Image:Phys QMS.png]] | ||
== | == Epidemiology/ Etiology == | ||
There are generally three mechanisms for quadriceps strain. | There are generally three mechanisms for quadriceps strain. | ||
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#rapid deceleration of an overstretched muscle (by quickly change of direction). | #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. <ref name="9">Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.</ref><ref name="10">Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Wilkins, 656p</ref>'''<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. <ref name="9">Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.</ref><ref name="10">Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Wilkins, 656p</ref>'''<br>''' | ||
== | 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, a high percentage of Type II fibers in the muscle, and so on. Another possible cause of strain injury can be a bad warming-up before an exercise or no warming-up at all. The majority of quadriceps strains (incurred by kicking sports) are located in the dominant leg, because it is the preferred kicking leg which is used more often.'''<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><ref name="5" />''' | ||
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== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
Typically a muscle strain is characterized by a violent muscle contraction occurring simultaneously with an excessively forced stretch. The vast majority of muscle strains involve muscles that pass over two joints or more or occur in muscles with complex architecture (Brewer 1962). In the anterior thigh the rectus femoris is most vulnerable to strains. | |||
Various ways of grading muscle strains have been proposed. Factoring in pain, loss of strength, and physical exam findings in a grading system helps provide guidance for treatment, rehabilitation, and eventual return to play. The table below provides an outline of a clinical grading system for muscle strains.<ref name="5" /> | |||
*Grade 1 strains represent minor tearing of muscle fibers with only minimal or no loss in strength. Pain is usually mild to moderate with no palpable defect in the muscle tissue on exam.<ref name="5" /><br> | |||
*Grade 2 strains involve more severe disruption to the muscle fibers with significant pain and loss of strength. A defect in the muscle tissue may sometimes be felt. <ref name="5" /> | |||
*Grade 3 strains are a result of complete tearing of the muscle with associated severe pain and complete loss of strength. A palpable defect in the muscle tissue can frequently be felt, especially if examined at onset of injury prior to hematoma formation.<ref name="5" /> | |||
[[Image:Qms_2.png]] | |||
Although most of the times trauma history is associated, evaluation methods can be used to identify the strained muscle. | Although most of the times trauma history is associated, evaluation methods can be used to identify the strained muscle. | ||
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*Muscle strengh | *Muscle strengh | ||
*Skin temperature | *Skin temperature | ||
*Pain | *Pain(while flexing, stretching or using the muscles)<ref name="department" /> | ||
*Muscle spasms<ref name="department" /> | |||
*Swelling<ref name="department" /> | |||
*Bruises, if the blood vessels are broken/damaged<ref name="department" /><br><br> | |||
== Differential Diagnosis == | == Differential Diagnosis == | ||
*Contusion | *[http://www.physio-pedia.com/Quadriceps_Muscle_Contusion Contusion] | ||
*Jumper's Knee | *[http://www.physio-pedia.com/Patellar_Tendinopathy Jumper's Knee] | ||
*Femoral Neck Stress Fracture | *[http://www.physio-pedia.com/Femoral_stress_fracture Femoral Neck Stress Fracture] | ||
*Slipped Capital Femoral Epiphysis<ref name="medscape">Medscape. Drugs And Diseases: Slipped Capital Femoral Epiphysis. http://emedicine.medscape.com/article/91596-overview (accessed November 23, 2014)</ref> | |||
== Examination == | == Examination == | ||
Revision as of 15:00, 23 May 2016
Original Editors - Maxime Tuerlinckx
Top Contributors - Mandeepa Kumawat, Maxime Tuerlinckx, Carlos Areia, Lucinda hampton, Shanna Blyckaerts, Admin, Shaimaa Eldib, Jelle Van Hemelryck, Kim Jackson, Wanda van Niekerk, Rachael Lowe, Frederik Töpke, WikiSysop, Joao Costa, Claire Knott, Scott Buxton, Naomi O'Reilly, Daphne Jackson, Fasuba Ayobami, 127.0.0.1, Rucha Gadgil and Evan Thomas
Search strategy[edit | edit source]
We looked after information on different databases like Web of Science, PubMed, PEDro, Web of Knowledge, etc. The keywords that we used were quadriceps muscle strain, muscle strain, quadriceps strain, quadriceps strain therapy, quadriceps injury, muscle injury, etc.
Definition/Description[edit | edit source]
A quadriceps muscle strain is an acute tearing injury of the quadriceps,more specific a partial tear of the small fibers of the muscles that make up the quadriceps group.[1] 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]
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 quadriceps femoris acts as a hip flexor and knee extender. This muscle is composed of 4 subcomponents:
- Rectus femoris
- -Vastus medialis
- -Vastus lateralis
- Vastus intermedius
The rectus femoris originates at the ilium, thus crossing both the hip and knee joint along its course. The remaining muscles originate on the femur. These four muscles are innervated by the femoral nerve.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
These four muscles come together in the quadriceps tendon and insert to the base of the patella.
The true insertion of the quadriceps femoris is into the tibial tubercle, but convention considers it as inserting into the patella through the quadriceps tendon or the suprapatellar tendon. The part distal to the sesamoid bone is known as the patellar ligament (ligamentum patellae), patellar tendon, or infrapatellar tendon.[2]
The 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 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
Muscle functions:
-Rectus Femoris: Hip flexion, Knee extension
-Vastus Lateralis: Knee extension
-Vastus Intermedius: Knee extension
-Vastus Medialis: Knee extension
-Semitendinosus: Hip extension, Knee flexion
-Semimembranosus: Hip extension, Knee flexion
-Biceps Femoris: Hip extension, Knee flexion
Epidemiology/ Etiology[edit | edit source]
There are generally three mechanisms for quadriceps strain.
- Sudden deceleration of the leg (kicking),
- violent contraction of the quadriceps (sprinting) and
- 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. 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 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, a high percentage of Type II fibers in the muscle, and so on. Another possible cause of strain injury can be a bad warming-up before an exercise or no warming-up at all. The majority of quadriceps strains (incurred by kicking sports) are located in the dominant leg, because it is the preferred kicking leg which is used more often.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
Characteristics/Clinical Presentation[edit | edit source]
Typically a muscle strain is characterized by a violent muscle contraction occurring simultaneously with an excessively forced stretch. The vast majority of muscle strains involve muscles that pass over two joints or more or occur in muscles with complex architecture (Brewer 1962). In the anterior thigh the rectus femoris is most vulnerable to strains.
Various ways of grading muscle strains have been proposed. Factoring in pain, loss of strength, and physical exam findings in a grading system helps provide guidance for treatment, rehabilitation, and eventual return to play. The table below provides an outline of a clinical grading system for muscle strains.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- Grade 1 strains represent minor tearing of muscle fibers with only minimal or no loss in strength. Pain is usually mild to moderate with no palpable defect in the muscle tissue on exam.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Grade 2 strains involve more severe disruption to the muscle fibers with significant pain and loss of strength. A defect in the muscle tissue may sometimes be felt. Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Grade 3 strains are a result of complete tearing of the muscle with associated severe pain and complete loss of strength. A palpable defect in the muscle tissue can frequently be felt, especially if examined at onset of injury prior to hematoma formation.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title
Although most of the times trauma history is associated, evaluation methods can be used to identify the strained muscle.
Examples of evaluation methods:
- Hamstrings/Quadriceps ratio (H : Q)
- Range of motion (ROM) and End-feel
- Muscle strengh
- Skin temperature
- Pain(while flexing, stretching or using the muscles)[1]
- Muscle spasms[1]
- Swelling[1]
- Bruises, if the blood vessels are broken/damaged[1]
Differential Diagnosis[edit | edit source]
- Contusion
- Jumper's Knee
- Femoral Neck Stress Fracture
- Slipped Capital Femoral Epiphysis[3]
Examination[edit | edit source]
Its often present:
- Tenderness provoked by direct palpation at the injury site.
- Pain during resisted extension
Medical Management
[edit | edit source]
The use of NSAID's ( nonsteroidal anti-inflammatory drugs) is still contorversial, their benefit, cost and potential adverse effects may be taken into consideration. If used, it should be during the inflamatory period (48h-72h) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Surgical Intervention may be necessary if there is a complete quadriceps muscle rupture.
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 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
Recent Related Research (from Pubmed)
[edit | edit source]
References
[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Department of pediatrics. Quadriceps strain. http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/quadriceps-strain (accessed 17 November 2014)
- ↑ Waligora AC, Johanson NA, Hirsch BE. Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee. Clin Orthop Relat Res. 2009; 467(12): 3297–3306 (2A)
- ↑ Medscape. Drugs And Diseases: Slipped Capital Femoral Epiphysis. http://emedicine.medscape.com/article/91596-overview (accessed November 23, 2014)
