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Quadriceps Injury Workup

  • Author: Thomas M DeBerardino, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: May 13, 2014
 

Laboratory Studies

Blood studies are not generally indicated when the patient's history is that of overuse or sudden trauma. However, if the history and physical examination findings are suggestive of renal disease, hyperparathyroidism, soft tissue tumor, or diabetes mellitus, the appropriate studies should be sent.

The following are indicated for severe contusions and ill-appearing patients:

  • Creatine kinase
  • Hematocrit
  • Coagulation studies - If patient develops spontaneous edema or is taking anticoagulants
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Imaging Studies

Initially, imaging studies may not be indicated in patients with partial rectus tears, minimally symptomatic quadriceps contusions, and mild quadriceps tendinitis. These patients have a history of acute or repetitive trauma, and the history and physical examination findings are consistent with these working diagnoses. For patients in whom the history and physical examination findings are not consistent, for patients with night pain, patients with suspected complete quadriceps rupture, those with significant quadriceps contusion, and in patients where fracture (femur or patellar), metabolic disease, or tumor is suspected, radiography is indicated on the first visit.

For patients with mild tendinitis, mild contusions, and partial rectus tears who do not respond to activity modification, rest, and physical therapy, radiography is indicated on follow-up examination.

In patients with quadriceps contusion, plain radiography may show evidence of myositis ossificans at the site of the contusion several weeks to months after injury.

Patients who have quadriceps tendinitis or partial tears of the rectus tendon may have the radiographic findings of the so-called saw tooth patella along the proximal border of the patella.

Patients with complete rupture of the tendon may have an associated patellar fracture, particularly if the patient fell on the flexed knee at the time of the injury. The radiographs in patients with complete rupture show obliteration of the quadriceps tendon shadow, patella baja, and a large effusion. A suprapatellar mass (the retracted quadriceps muscle) or a suprapatellar calcific density may also be present.

If quadriceps tendon rupture is diagnosed clinically, anteroposterior (AP) and lateral views of the knee are the minimum views required. The lateral view shows a low-riding patella, patella baja, due to the unopposed pull of the patellar tendon.

CT scanning is not usually as helpful as MRI.

Ultrasonography is less expensive than the MRI and has a high sensitivity and specificity for complete tears. Its accuracy and predictive value in partial tears is not as good.

MRI has the highest sensitivity and specificity for disorders of the quadriceps. It shows both complete and partial ruptures, soft tissue hematomas, tendinopathies, soft tissue tumors, myositis ossificans, and fascial defects. Incomplete intrasubstance tears of the rectus femoris and complete tears of the rectus femoris and quadriceps tendon are visible as increased signal intensity on the T2 images. Incomplete intrasubstance ruptures of the rectus tendon and the quadriceps tendon image as focal disruptions of the normal laminated appearance of the tendon.

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Other Tests

Compartment pressure measurements should be taken if compartment syndrome is suspected in the anterior thigh.

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Procedures

Compartment pressures should be measured if a compartment syndrome is suspected.

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Contributor Information and Disclosures
Author

Thomas M DeBerardino, MD Orthopedic Surgeon, The San Antonio Orthopaedic Group; Research Director, BRIO of the San Antonio Orthopaedic Group; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician; Adjunct Associate Professor, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Herodicus Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; Ivy Sports Medicine; MTF; Aesculap; The Foundry, Cotera; ABMT<br/>Received research grant from: Histogenics; Cotera; Arthrex.

Coauthor(s)

Leslie Milne, MD Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.

References
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Place knee passively in 120º of flexion and immobilize with a double elastic wrap in a figure-8 fashion. This should occur within minutes of the injury. Used with permission courtesy of John Aronen, MD.
Modified treatment of quadriceps contusion. Used with permission courtesy of John Aronen, MD.
 
 
 
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