Quadriceps contusions, along with strains, are among the most common injuries in athletics. A quadriceps contusion is a traumatic blow to the anterior (front), lateral (outside) or medial (inside) aspect of the thigh. They occur primarily in contact and collision sports such as football, soccer, lacrosse and basketball.
They are characterized by pain along the injury site, pain during passive range of motion, swelling, discoloration, decreased range of motion, decreased strength and loss of overall function. The extent of a quadriceps contusion is based on a variety of factors, including the amount of force occurring during injury, the degree of muscular relaxation (which determines the depth of the injury) and any previous trauma to the injury site. As a result, patients with a quadriceps contusion will present with varying degrees of severity.
Grade I (Mild)
Consists of superficial intramuscular bruising that produces mild bleeding and swelling, little pain and mild point tenderness along the injury site. There is little or no loss of range of motion. The patient will have active knee range of motion >90°.
Grade II (Moderate)
Consists of a deeper bruise consisting of moderate pain, swelling and discoloration along the injury site. Active knee range of motion is between 45° and 90°. The patient will demonstrate an obvious limping gait, possibly favoring the involved leg.
Grade III (Severe)
Consists of deep intramuscular mass, possibly causing it to bulge outward. Symptoms include severe pain, loss of function, and increased amount of edema and ecchymosis. Active knee range of motion is <45°.
Initial treatment of a quadriceps contusion consists of limiting hemorrhage, mainly accomplished by RICE. When applying ice, instruct the patient to keep the knee flexed to facilitate the healing process. For Grades II and III, the patient should be given crutches with the leg wrapped in an ace bandage in a knee-flexed position.
After the acute phase, the patient can be discharged from the crutches when they demonstrate good quad control and a normalized gait. The patient can then progress to pain-free isometric quadriceps exercises and mild stretching to restore range of motion.
Return to pain-free functional rehabilitation, including strength, endurance and sport-specific drills.
Generally, quadriceps contusions should be managed conservatively. The decision to recommend return-to-sport should not come until the patient is free of pain. Additionally, care must be taken to avoid repeated trauma to the area, including providing proper protective equipment such as a thigh pad.