injuries of the thigh and lower leg Flashcards
Describe a quadriceps contusion
- **bruising to the quads **with a resulting haematoma
- usually due to a** direct blow **to the thigh
- very common esp in contact sport eg rugby, GAA, hockey etc
what is an intramuscular vs intermuscular haematoma?
- intramuscular - inside the muscle
- intermuscular - outside the muscle
what is a grade I quad contusion?
- superficial intramuscular bruising that produces mild bleeding and swelling
- little pain and mild point tenderness
- active knee rom is greater than 90 degrees
what is a grade II quad contusion?
- deeper bruise, moderate pain and swelling and discolouration
- active knee ROM is between 45 and 90 degrees
- may have antalgic gait - limping
what is a grade III quad contusion?
- deep intramuscular bruising
- pain may be more severe
- oedema and bruising
- active knee ROM is less than 45 degrees
- may report more loss of function
what are the signs of a quad muscle lesion on contraction, stretch and palpation?
- contraction - pain and weakness on resisted extension
- stretch - reduced ROM due to pain
- palpation - pain over area and palpable haematoma
what is the acute management of a quad contusion involve?
- stop playing
- POLICE
- crutches
- strapping
- no heat, massage, forcefyl stretching or injection in first 72 hours
what is there a risk with if the contusion is severe?
there is a risk of rebleed in 7-10 days
what does the rehab progression of a quadricep contusion involve?
- NSAIDS’s
- gentle knee AROM
- NWB exercises eg cycling or swimming
- isometric quads and hamstring exercises
- progress to concentric and eccentric strengthening
- progress weight bearing
what is a complication that can arise with a quadricep contusion & how might this arise?
- myositis ossificans
- when the quads bleed, a cascade of cellular responses can occur and cause heterotrophic bone formation
which quadricep muscle is most likely to tear/strain?
rectus femoris - as connected to 2 joints
what is the rehab of a quadricep muscle strain similar to?
quad contusion rehab
describe the pathology of a hamstring strain
- eccentric injury
- injured during high speed running
- mainly the biceps femoris
- injured with hip flexion and knee extension -= eg kicking or sprinting
what are the non modifiable risk factors for a hamstring strain?
- age
- previous injury
- race/ ethnicity
what are the modifiable risk factors with a hamstring strain?
- strength
- lumbopelvic core stability
- fatigue
- muscle characteristics
- fitness level
- training volumes
describe a grade I hamstring strain
- microtearing of a few muscle fibres
- local pain and slight pain with muscle activation and stretch
- tightness and stiffness
- minimal strength loss
describe a grade II hamstring strain
- moderate tearing of muscle fibres
- local pain but a larger area
- greater pain with muscle stretching and activation
- stiffness, weakness and possible bruising
- limited ability to walk for 24-48 hours
Describe a hamstring grade III tear
- complete tear of the muscle
- swelling and bruising
- possible palpable mass of muscle tissue at the tear site
- extreme difficulty or inability to walk
what kind of clinical signs and symptoms are picked up in a patient with a suspected hamstring strain in a subjective exam?
- acute episode of overload or specific trauma
- there may or may not be a popping sensation
- functional loss and difficulty with walking - as hamstrings are important during the swing phase of gait
what would be observed in a physical exam of a hamstring strain?
- possibly antalgic gait
- swelling and pain on palpation
- reduced AROM and PROM
what does the rehab (first 0-7 days) after a hamstring strain involve?
- POLICE
- pain free ROM
- gradually introduce stretching
- soft tissue massage and trigger point release
- NSAIDS - useful for severe strains
what does rehab (7 days onwards) of a hamstring strain involve?
- increasing ROM
- strengthening - isometric first then progressing to concentric and eccentric
- sport specific training
How can you prevent hamstring injuries?
- warm ups
- stability training
- strength training
- flexibility exercise
- nordic hamstring exercise
under what circumstances would surgical repair of a hamstring be advised?
- certain proximal and distal avulsion injuries (when forceful muscle contraction pulls off some bone)
- recommended when 2 tendons are retracted
what are the 2 heads of the gastrocnemius muscle called?
- medial head
- lateral head
why is the gastrocnemius vulnerable to injury?
- as it crosses the 3 joints - knee, ankle and subtalar joint
describe the epidemiology of a calf muscle strain
- occurs in sport in younger patients - eg soccer, tennis, long distance running
- prevalent in middle to older ages
what can cause (aetiology) a calf muscle strain?
- sudden eccentric contraction, acceleration from a stationary position
- eg lunge forward, foot drops into dorsiflexion
what can be picked up during a subjective exam of a patient with a suspected calf strain?
- sudden sharp pain over muscle belly
- if deeper, poorly localised pain and also cramping injury
- feeling as if you have been kicked
- may report swelling and bruising
- difficulty weightbearing and walking
what can be observed in a physical exam of a calf strain?
- observing for swelling & bruising
- antalgic gait
- contraction test -unable to either double or single leg heel raise
- palpation - tender at site of muscle tear
describe a grade I calf strain
- sharp pain
- may be able to continue playing
- pain on unilateral calf raise
- time frame before return to sport -= 10-12 days
Describe a grade II calf strain
- unable to continue activity
- pain in unilateral calf raise
- limited dorsiflexion
- time frame for return : 2-4 weeks
describe a grade III calf strain
- unable to continue activity as there is severe pain
- thompson test is positive
- may need surgery
what are other conditions that may present similarly to a calf strain?
- DVT
- DOMS
- achilles tear or rupture
- achilles tendinopathy
- lumbar spine referral
what does the physiotherapy management of a calf strain involve?
- may be conservative or surgical depending on the grade of tear
- early loading
- protected WB
- isometric exercises
- calf raises as soon as possible
- retrain balance and proprioception
what would the surgical management of a grade III calf strain involve?
- immobilised 6-8 weeks or surgical repair followed by immobilisation x 6-8 weeks
- graded return to full weight bear
- restoring ROM strength and function
- graded return to sport
