What is It?
A quadriceps ("quad") contusion is commonly known as a “thigh bruise”. The quadriceps is a group of four muscles that runs down the front of the thigh from the hip to the knee, and a quad contusion occurs from forceful impact anywhere in that area. A quad contusion is one of the most common injuries in contact sports, such as American football.

Symptoms
Common symptoms of a quad contusion include pain at the site of impact, bruising, and decreased range of motion, which may cause difficulty walking. Swelling and deformity of the muscle may also be noted.

Sports Medicine Evaluation and Treatment
Quad contusions are typically classified into three categories or “grades”. A doctor will assess this severity with a physical exam, which will include inspection of the area to look for any bruising, as well as palpation of the thigh to assess for swelling or deformity. Strength testing of the muscle will also be performed. A sports medicine physician may use diagnostic ultrasound to visualize muscle fibers. An X-ray may or may not be needed depending on what the doctor finds during the physical exam, and very rarely will magnetic resonance imaging (MRI) be needed.

One possible complication of this condition is “myositis ossificans,” which indicates unexpected transformation of the muscle into bone within the site of injury. Myositis ossificans may develop in up to 20 percent of quad contusions if inadequately treated and will lead to prolonged recovery. After the injury has occurred, prevention of myositis ossificans can best be achieved by avoiding early heat or massage. Therapeutic ultrasound treatments, a form of deep heat, should also be avoided during the acute, painful stage. Treatment of a quad contusion consists of early icing and compression wrap. Bracing may be used to keep the knee in a flexed position. Keeping the knee in a flexed position initially can significantly speed healing in more severe injuries. Gentle stretching and massage may be used after a brief period of rest (usually about 24 hours). The doctor may also recommend the use of anti-inflammatory medications.

Injury Prevention
This injury is best prevented by using proper protective equipment in any sport where impact in this area is likely (for example, wearing thigh pads in football). Because a significant amount of time can be lost from quad contusions, the use of thigh pads should be encouraged by coaches and team medical staff.

Return to Play
The timeframe for returning to play varies widely based off the severity of the injury. One study showed that average disability time varied from approximately 2 to 3 weeks; however, some severe injuries may take much longer. In order to return to participation after a quad contusion, the player should be able to demonstrate full, pain-free range of motion and should be able to perform all aspects of functional activity needed to participate.

AMSSM Author Members: Author: Nicholas R. Phillips, M.D.

References
Kary, JM. Diagnosis and management of quadriceps strains and contusions. Curr
Rev Musculoskelet Med (2010) 3:26-31.

MackKnight, JM. Football. In O’connor FG, et al. ACSM’s Sports Medicine: A comprehensive review. pp629, Philadelphia, PA: Lippincott Williams & Wilkins