Quadriceps Contusion or Tear?
When covering a rugby match last Saturday, Kieran (Assumed name), one of my players went down in a ruck. There were so many players around that I could not get a clear vision of the mechanism of injury (a very important factor in helping establish between a contusion or tear). I ran on and was faced with my player in immense pain to the point he could not verbally tell me or even show me where he was feeling pain at that time. As minutes passed on the pitch he slowly began to calm and the initial pain felt had decreased. I could now find out he had pain in the top of his quadriceps.
After a little more time and help from others, Kieran was taken off the pitch into the dugout where I compressed from below to knee to as high up on the thigh as I could go, applied ice and also provided him with crutches to keep weight off the injured limb.
So now I was faced with – Is this a quadriceps contusion or tear?
What is a quadriceps tear?
MOI (Mechanism of Injury) ?
• Tears can occur due to a variety of reasons such as falls, direct force to the front of the knee and a heavy load on the leg with the foot planted and the knee partially bent.
• Dependent on grade of strain (1-3)
• Pain on palpation, stretching and contraction
• Swelling (varies with grade)
• In grade 3 there is a palpable defect in the muscle
• Muscle spasm
• Pain on weight bearing
What is a quadriceps contusion?
• In simple terms this is a blunt trauma to the thigh that causes bleeding deep within the muscle.
• Result of a direct impact of the quadriceps
• Pain and tenderness on palpation
• Pain on stretch and muscle contraction
• Difficulty weight bearing
So my findings…….
Monday came around; this was 2 days post injury. Over the two days Kieran followed the R.I.C.E principal and also had the use of crutches. At the appointment a detailed subjective assessment was carried out before an objective assessment. Within the subjective assessment Kieran stated he could not weight bear, he felt weak, and that he remembers going in for a tackle and he thinks he had a direct impact on the knee which bent his thigh back quickly. Kieran then also presented with extreme loss of ROM, a significant decrease in strength, pain on movement, bruising at the site of pain, pain on palpation and stretch and pain on weight bearing. Along with further questions and tests it was established Kieran had sustained a grade 2 rectus femoris strain, and is now on his way to a full recovery and will return soon to playing the sport he loves.
Many injuries can be treated thoroughly when a subjective assessment takes place; this helps you to specifically establish what has gone on and the right treatment for you.
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