Soft Tissue Injury 1

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SOFT TISSUE INJURY OF THIGH


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Quadriceps Injury Adductor Strain

2Soft tissue injury | Moksha Nidhi | 2014-08-22 | Indraprastha Apollo Hospital


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Highlight points

1. Basic anatomy and muscle action

2. Mechanism of injury.

3. Signs and symptoms

4. Treatment and Management

Soft tissue injury | Moksha Nidhi | 2014-08-22 | Indraprastha Apollo Hospital 3


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Quadriceps Injury


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Basic Anatomy



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Muscle action

All four quadriceps are powerful

extensors of the knee joint.

They are crucial in walking, running,

jumping and squatting.

It is also a flexor of the hip.



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Types of Quadriceps Injury

Avulsion of the iliac spine - Rare

Quadriceps strain - Less common

Quadriceps contusion - Most common



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Quadriceps strain

Muscle belly strains caused by muscle being overstretched

during contraction

Mistiming a kick - Missing the ball and hitting the ground

Rapid deceleration- When hurdler cathes a toe



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Contributing factors are

Tight quadriceps muscles

Muscle imbalance

Inadequate cool down or warm up



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Rectus femoris is most commonly injured

and are graded as

Grade 1- Minimal disruptions

Grade2- Tearing with significant haemorrhage

Grade3- Complete loss of continuity and function



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Signs and Symptoms

Pain more in I & II degree strain

1stdegree patient is able to run but not able to sprint or

jump or kick.

2nddegree patient not able to continue activity.

3rddegree pain swelling and visible or palpable defect and

unable to do straight leg raise



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Quadriceps contusion/Charlie horse, Cork injury

Common site is anterior lateral thigh

Mostly seen in football rugby, soccer,

basket ball and hockey



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Treatment and Management

Phase one 24- 48 hours

ICEup to 20 minutes each hour

Compression dressing in knee flexed position

No weight or partial weight bearing with crutches

Gentle active range of motion in pain free range



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Phase two 2-5 days

If range of motion is not possible continue non weight bearing

Modalities like ultrasound or high voltage galvanic stimulationcan be given

Start with isometric strongly resisted hamstring work if active

range of motion is achieved

Light partial weight bearing can be allowed



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Phase three

Discontinue crutches full weight bearing

Work on active range of motion

Gentle quadriceps stretching

Increase resisted quadriceps work

High voltage galvanic stimulation

X ray at 3 weeks to rule out myositis ossificans



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Phase four

Range of motion is within 10 degree of normal or full

Achieve normal flexibility

Normal quadriceps strength

Normal power balance

Can now start jumping start or stop in sprinting



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Adductor strain

Adductor strain


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Basic Anatomy and Muscle action

All four are powerful adductor of the hip joint.



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Adductor Strain

Strains usually occurs at the myofascial junction and more

frequently in adductor longus.

Caused due to sudden overextension or stretching ininadequately warmed up muscle.

Commonly seen in ice hockey, soccer, high jump, water skiing

and football.



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Adductor longus is most commonly injured

and are graded as

Grade 1- Minimal disruptions - Common

Grade2- Tearing with significant haemorrhage - Common

Grade3- Complete loss of continuity and function - Rarely



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Adductor longus is most commonly injured

and are graded as


A mild (Grade 1) groin strain may not be very painful and may not limit mild or

moderate physical activity.

A moderate (Grade 2) sprain causes moderate discomfort and limits or prevents

running and jumping.

A severe (Grade 3) strain causes pain doing almost anything and could include any

of the symptoms.


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Signs and Symptoms

A stabbing pain in the groin area.

Swelling and/or bruising that may develop several days after

the injury.

Inability to move the leg inward or across the front of your body.

Loss of upper leg strength with certain movements

Muscle spasms

In rare cases, muscle deformity



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Grade 1 symptoms usually disappear within a week.

Grade 2 symptoms last 2-3 weeks.

Grade 3 symptoms can persist for 6-8 weeks or longer.



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Dont try to come back too soon.Absence of symptoms while

performing normal daily activities is deceiving and different from

the forces involved in training or competition.

No brisk walking, jogging, or running as long as you have

moderate-to-severe pain.

Once the pain disappears, gradually increase the intensity,

duration, and frequency of training.

Go through all the movements required in your sport without

pain before returning to action.



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Phase one 12-72 hours

Apply ice packs to the area for 15-20 minutes,

3-4 times a day to minimize swelling and pain.

Compression dressing

Use an elastic wrap or bandage to apply pressure and limit swelling

Gentle active range of motion in pain free range

Rest - Take 5-7 days off

Analgesics and anti-inflammatory drugs



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Phase two 2-5 days

If range of motion is not possible continue further exercises.

Modalities like ultrasound or high voltage galvanic stimulation

can be given.

Gentle stretching exercise.

Light resisted exercises.

Activities like stair climbing and cycling.



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Phase three

If pain is completely not presented strength is 80 percent as

compared to normal side on isokinetic testing.



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Contact:

Moksha Nidhi

Senior Physiotherapist Indraprastha Apollo Hospital

[email protected]



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Soft tissue injury | Moksha Nidhi | 2014 08 22 | Indraprastha Apollo Hospital 30

Soft Tissue Injury 1

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