Proximal Quadriceps Strain
What is it: Injury to the quadriceps muscle-tendon units (rectus femoris, vastus medialis, vastus intermedius, vastus lateralis). Acute strains and overuse injuries as well as a quadriceps contusion caused by a direct-blow can be seen.
How does it present: Patients usually present with anterior thigh pain with activity, in some cases after trauma to the thigh.
Common exam findings: Swelling and tenderness at the injury site may be appreciated. Pain may be worsened with stretching or resisted contraction of the muscle. Pain with resisted straight-leg hip extension isolates the rectus femoris and suggests injury to this portion of the quadriceps. Ely's Test assesses for rectus femoris spasticity.
Tests and treatment: Radiographic studies are often not needed to make the diagnosis, but in the case of large contusions to the quadriceps, can be used to evaluate for the development of myositis ossificans. Treatment is generally conservative and physical therapy may be beneficial. In cases of large contusions of the quadriceps initial compression and icing should be considered.