(65) 64712744|info@boneclinic.com.sg

Quadriceps Strain

A quadriceps strain is a tear in one of the quadriceps muscles at the front of the thigh. It can range from a mild discomfort to a full blown tear of most of the muscle

Symptoms of a thigh strain

Quadriceps strains are graded 1,2 or 3 depending on severity.

Grade 1

  • A twinge in the thigh is usually felt.
  • A general feeling of tightness in the thigh.
  • Mild discomfort on walking.
  • Probably no swelling.
  • Trying to straighten the knee against resistance may be uncomfortable (see assessment).
  • An area of local spasm may be felt at the site of the suspected tear.

Grade 2

  • A sudden sharp pain when running, jumping or kicking.
  • Unable to play on.
  • Pain affects walking.
  • The athlete may notice swelling or even mild bruising.
  • Pain on feeling the area of the tear.
  • Straightening the knee against resistance causes pain.
  • Unable to fully bend the knee

Grade 3

  • Sudden, severe pain in the thigh.
  • Unable to walk without the aid of crutches.
  • Bad swelling appearing immediately.
  • Bruising usually appears within 24 hours.
  • A static contraction will be painful and might produce a bulge in the muscle.
  • Expect to be out of competition for 6 to 12 weeks.

What is a Quadriceps strain?

The quadriceps muscles are the muscles on the front of the thigh. They consist of the Vastus lateralis, Vastus medialis, Vastus intermedius and the Rectus femoris. A strain is a tear in the muscle. These can range in severity, from a very small tear to a complete rupture.

Tears to the quadriceps muscles usually occur following an activity such as sprinting, jumping or kicking, especially if a thorough warm-uphasn’t been undertaken. Any of these muscles can strain (or tear) but probably the most common is the Rectus femoris. This is because it is the only one of the four muscles which crosses both the hip and knee joints. This make it more susceptible to injury. The most common site of injury is around the musculotendinous junction (where the muscle becomes tendon), just above the knee.

Injuries that occur following a direct impact to the muscle, such as being hit by a ball or other hard object, are more likely to becontusions and should be treated slightly differently.

Treatment for grade 1 quad strains

What can the athlete do about it?

  • Apply the R.I.C.E (rest, ice, compression, elevation) procedure for the first 24 hours.
  • Apply cold therapy as soon as possible and every 2-3 hours.
  • Use a compression bandage until you feel no pain.
  • Rest for at least 72 hours before commencing light training.
  • If there is no pain, continue with training.
  • See a sports injury professional.

What can a sports injury specialist do?

  • Use sports massage techniques to speed up recovery (very important).
  • Use ultrasound and electrical stimulation.
  • Prescribe a rehabilitation programme.

Treatment for a grade 2 strain

What can the athlete do about it?

  • Use the R.I.C.E procedure as above.
  • Apply cold therapy straight away and every 2-3 hours for 48 hours.
  • Wear a compression bandage and rest with the leg elevated.
  • Use crutches if necessary.
  • See a sports injury specialist.

What can a sports injury specialist do?

  • Use sports massage techniques to speed up recovery (very important).
  • Use ultrasound and electrical stimulation.
  • Prescribe a rehabilitation programme.

Treatment for a grade 3 thigh strain

What can the athlete do about it?

  • Stop play immediately.
  • Rest with the leg elevated, using a compression bandage.
  • Apply cold therapy immediately.
  • Seek medical attention. It is important you do this if you suspect a grade three strain. If you do not you may be permanently injured or weakened.

What can a sports injury specialist do?

  • Use sports massage techniques to speed up recovery (very important).
  • Use ultrasound and electrical stimulation.
  • Prescribe a rehabilitation programme and monitor it.
  • Operate if needed (rare).

Stop the pain and get your Quadriceps checked. Call +65 6471 2744 / Email to: info@boneclinic.com.sg

Iliopsoas Impingement

Iliopsoas impingement may be present in both natural and artificial hips.

In the case of a natural hip, it has been theorized that because of its close relationship to the anterior hip, a tight iliopsoas tendon may be a cause of anterior labral lesions. The clinical presentation of this form of iliopsoas impingement may not be accompanied by a snapping phenomenon and have positive impingement tests, log roll and mechanical hip symptoms more in accordance with symptoms related to a labral tear.

When iliopsoas impingement occurs in presence of total hip replacement (THR), affected patients typically report persisting groin pain that is exacerbated by stair climbing, getting into or out of bed or a chair and entering and exiting an automobile. A snapping phenomenon or a clunk is usually not present. Gait may be affected with the patient presenting a slight limp. It is important to remember that the patients must first be evaluated for more common causes of groin pain after THR like infection, component loosening and occult periprosthetic fractures. A typical finding at radiographs or CT is a protruding anterior implant rim uncovered by the bony anterior acetabular wall.

Conservative treatment for both conditions (iliopsoas impingement in natural and artificial hip joints) is the same including rest, NSAIDs and physical therapy. Iliopsoas injections are of limited therapeutic value, but they represent a very reliable diagnostic test. After failure of conservative treatment, surgical release of the iliopsoas tendon may be indicated.

In the case of iliopsoas impingement with a natural hip joint, hip arthroscopy will provide access for treatment of the associated lesions such as labral tears or underlying bony impingement.

When iliopsoas impingement is present in an artificial total hip joint, acetabular component revision for re-orientation and open iliopsoas release have been reported. Both techniques seem to be effective in the treatment of iliopsoas impingement with the open release of the iliopsoas tendon presenting less morbidity. It is also possible to perform endoscopic release of the iliopsoas tendon in a THR, but reported results in the peer-reviewed literature is limited.

Endoscopic release

Endoscopic release of the iliopsoas tendon has evolved over the past decade. A variety of surgical techniques is available for release of the iliopsoas tendon at different anatomical regions.

As described from proximal to distal, endoscopic release of the iliopsoas tendon may be transcapsular at two different sites: from the central compartment and from the hip periphery. It can also be performed within the iliopsoas bursa at its insertion on the lesser trochanter. For either one of these techniques, the patient is positioned for hip arthroscopy in supine or lateral decubitus.

Iliopsoas tendon from the central compartment is performed with the hip joint in traction. The anterolateral portal, as described by Byrd at the anterior superior corner of the greater trochanter, is used as the viewing portal. With a 70° arthroscope, the anterior capsule is identified. From the direct anterior portal, a radiofrequency hook probe or an arthroscopic banana knife is introduced to create an anterior hip capsulotomy relative to the 2 and 3 o’clock position of the labrum in a right hip or geographic zone 1. Fibers of the iliopsoas tendon are visualized through the capsulotomy. The tendon is further exposed using a mechanical shaver. A radiofrequency hook probe is used to release the tendon in a retrograde fashion leaving the iliacus muscle intact.

Iliopsoas tendon release from the hip periphery is performed without traction. A 70° or a 30° arthroscope is positioned into the peripheral compartment anterior and inferior to the femoral neck through the anterolateral portal. Landmarks at the hip periphery must be identified. The medial synovial fold serves as the best landmark to identify the inferior aspect of the head and neck (6 o’clock position). The proximal origin of the medial synovial fold at the inferior head-neck junction is visualized. The field of view is rotated to the anterior hip capsule. The mid anterior portal is used to introduce instruments into the peripheral compartment. Between the anterior inferior labrum and the anterior inferior zona orbicularis a capsulotomy is performed and the iliopsoas tendon fibers identified through the capsulotomy, in some cases a natural communication between the anterior hip capsule and the iliopsoas bursa is present at this level. The tendon is further exposed using a mechanical shaver. Finally, the iliopsoas tendon is released in a retrograde fashion using a radiofrequency hook probe. The iliacus muscle is left intact behind the released iliopsoas tendon.

Dead Leg – Quadriceps Contusion (Charley horse)

What is a contusion (or charley horse)?

This type of injury is very common in contact sports. An impact to the muscles can cause more damage than you might expect and should be treated with respect. The muscle is crushed against the bone. If not treated correctly or if treated too aggressively then Myositis Ossificans may result.

There are two types of contusion:

Intramuscular which is a tearing of the muscle within the sheath that surrounds it. This means that the initial bleeding may stop early (within hours) because of increased pressure within the muscle however the fluid is unable to escape as the muscle sheath prevents it. The result is considerable loss of function and pain which can take days or weeks to recover. You are not likely to see any bruising come out with this type – especially in the early stages.

Intermuscular which is a tearing of the muscle and part of the sheath surrounding it. This means that the initial bleeding will take longer to stop especially if you do not ice it. However recovery is often faster than intramuscular as the blood and fluids can flow away from the site of injury. You are more likely to see bruising come out with this one.

What are the symptoms of a charley horse?

  • It hurts because you have been whacked in the leg.
  • You might get swelling or bruising (see below).
  • Restricted movement is not uncommon.

After two to three days check:

  • If the swelling has not gone then you probably have an intramuscular injury.
  • If the bleeding has spread and caused bruising away from the site of the injury then you probably have an intermuscular injury.
  • If you are more able to contract the muscle you probably have an intermuscular injury.
  • Can you feel a deformation in the muscle or a gap ?

It is important the correct diagnosis is made because if you try to exercise on a complete rupture, or a bad intramuscular injury you can inhibit healing, make things worse or cause permanent disability. If you apply heat and massage in the early stages then you could get Myositis Ossificans (or bone forming within the muscle), then you are in trouble.

Like muscle strains, contusions are grade 1, 2 or 3 depending on the severity.

Grade 1: What does it feel like?

  • Tightness in the thigh.
  • Unable to walk properly.
  • Probably not much swelling.
  • Trying to straighten the knee against resistance probably won’t produce much pain.
  • Lying on front and bending the knee should allow you nearly a full range of motion.

What can the athlete do to combat charley horse?

  • Apply cold therapyand compression immediately. Use a compression bandage or heat retainer until you feel no pain.
  • See a sports injury professional.
  • Gentle pain free quadriceps stretching – hold for 30 secs, repeat 5 times daily.

What can a Sports Injury Professional or Doctor do?

  • Use sports massage techniques to speed up recovery (very important).
  • Use ultrasound and electrical stimulation.
  • Prescribe a rehabilitation programme.

Grade 2: What does it feel like?

  • Probably cannot walk properly.
  • Occasional sudden twinges of pain during activity.
  • Possible swelling.
  • Pressing in causes pain.
  • Straightening the knee against resistance causes pain.
  • Unable to fully bend the knee.

What can the athlete do?

  • Ice, compress, elevate, use crutches for 3 to 5 days.
  • See a sports injury professional.

What can a Sports Injury Specialist or Doctor do?

  • Use sports massage techniques to speed up recovery (very important).
  • Use ultrasound and electrical stimulation.
  • Prescribe a rehabilitation programme.

Grade 3: What does it feel like?

  • You will be unable to walk properly without the aid of crutches.
  • You will be in severe pain.
  • You will have bad swelling appear immediately.
  • A static contraction will be painful and might produce a bulge in the muscle.
  • Expect to be out of competition for 3 to twelve weeks.

What can the athlete do?

  • Seek medical attention immediately. R.I.C.E. (Rest, Ice, Compress, Elevate.) Use crutches.

What can a Sports Injury Specialist or Doctor do?

  • Use sports massage techniques to speed up recovery (very important).
  • Use ultrasound and electrical stimulation.
  • Prescribe a rehabilitation programme and monitor it.
  • Operate if needed.