Kategoriarkiv: Thigh

Muscle rupture in the anterioir thigh

Diagnosis: MUSCLE RUPTURE IN THE ANTERIOR THIGH
(RUPTURA MUSCULI)


Anatomy:
A rupture can in principle occur to all muscles in the thigh, however, ruptures most often happen in the anterior muscle (M quadriceps femoris) which has the function of stretching the knee and flexing the hip. The anterior thigh muscle consists of four muscles (M vastus lateralis, M vastus medialis, M rectus femoris and the deep lying M vastus intermedius).

 

  1. Spina iliaca anterior superior
  2. M. iliopsoas
  3. Lig. inguinale
  4. Tuberculum pubicum
  5. M. pectineus
  6. M. adductor longus
  7. M. gracilis
  8. M. adductor magnus
  9. M. rectus femoris
  10. M. sartorius
  11. M. vastus medialis
  12. Tractus iliotibialis
  13. M. vastus lateralis
  14. M. tensor fasciae latae et tractus iliotibialis
  15. M. gluteus medius

THIGH FROM THE FRONT

Cause: When a muscle is subjected to a load beyond the strength of the muscle (jump, kick), a rupture occurs. The vast majority of ruptures are partial muscle ruptures. The weakest point is often at the junction between the muscle tendon and the muscle belly. Muscle ruptures in children and adolescents are relatively rare compared with adults.

Symptoms: In slight cases a local tenderness is felt after being subjected to load (“sprained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). The following three symptoms are characteristic in connection with muscle injuries: pain upon applying pressure, stretching and activation of the muscle (stretching knee) against resistance. With total ruptures a defect can often be seen and felt in the muscle, and above and below the rupture a swelling can be felt (the contracted muscle belly and bleeding). The most frequent place for partial ruptures on the anterior thigh is approximately 10 cm below the upper front iliac crest projection (spina iliaca anterior superior) in the rectus femoris muscle.

Acute treatment: Click here.

Examination: In very slight cases (light muscle sprains) with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning can be performed, as it is the most suitable examination to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury (article).

Treatment: The treatment of the vast majority of muscle injuries today involves relief and rehabilitation. It is only in very rare cases that surgery is indicated (e.g. total rupture in the anterior muscle tendon close to the attachment on the upper knee cap where surgery is recommended very quickly (article). Even large ruptures in the thigh muscles will usually be able to be healed and rehabilitated without giving functional disorder (but often cosmetic disfigurement with an irregular thigh muscle).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.

Muscle rupture in the posterior thigh

Diagnosis: MUSCLE RUPTURE IN THE POSTERIOR THIGH
(RUPTURA MUSCULI)


Anatomy:
A rupture can in principle occur to all muscles in the rear of the thigh, however, ruptures most often happen in the large posterior muscles in the centre of the thigh (M biceps femoris, M semitendinosus, M semimembranosus) which have the function of stretching the hip and flexing the knee.

 

  1. M. biceps femoris (caput longum)
  2. M. semitendinosus
  3. Caput breve m. bicipitis femoris
  4. M. plantaris
  5. Tendo m. bicipitis femoris
  6. M. gastrocnemius
  7. M. sartorius
  8. M. gracilis
  9. M. semimembranosus

THIGH FROM THE REAR

Cause: When one of the posterior thigh muscles is subjected to a load beyond the strength of the muscle (typically sprinting), a rupture occurs. The vast majority of ruptures are partial muscle ruptures. Muscle ruptures in children and adolescents are relatively rare compared with adults.

Symptoms: In slight cases a local tenderness is felt after being subjected to load (“sprained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). The following three symptoms are characteristic in connection with muscle injuries: pain upon applying pressure, stretching and activation of the muscle (flexing knee) against resistance. With total ruptures a defect can often be seen and felt in the muscle, and above and below the rupture a swelling can be felt (the contracted muscle belly and bleeding). The most frequent place for partial ruptures on the posterior thigh is the large posterior muscles in the centre of the thigh (M biceps femoris, M semitendinosus, M semimembranosus) which have the function of stretching the hip and flexing the knee.

Acute treatment: Click here.

Examination: In very slight cases with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning (or MRI scanning) can be performed, as these are the most suitable examinations to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury (article).

Treatment: The treatment of the vast majority of muscle injuries today involves relief and rehabilitation. It is only in very rare cases that surgery is indicated Even large ruptures in the thigh muscles will usually be able to be healed and rehabilitated without giving functional disorder (but often cosmetic disfigurement with an irregular thigh muscle).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.

Muscular bleeding in the anterior thigh

Diagnosis: MUSCULAR BLEEDING IN THE ANTERIOR THIGH
(HAEMATOMA MUSCULI)


Anatomy:
The thigh muscles are dealt up in three muscle groups (muscle compartments) of powerful, partially unyielding, muscle membranes (fascias): a front, an inner and a rear muscle compartment. The anterior thigh muscle consists of four muscles (M vastus lateralis, M vastus medialis, M rectus femoris and the deep lying M vastus intermedius).

 

  1. Spina iliaca anterior superior
  2. M. iliopsoas
  3. Lig. inguinale
  4. Tuberculum pubicum
  5. M. pectineus
  6. M. adductor longus
  7. M. gracilis
  8. M. adductor magnus
  9. M. rectus femoris
  10. M. sartorius
  11. M. vastus medialis
  12. Tractus iliotibialis
  13. M. vastus lateralis
  14. M. tensor fasciae latae et tractus iliotibialis
  15. M. gluteus medius

THIGH FROM THE FRONT

Cause: If a muscle is subjected to kicks or the like the muscle belly, which contains blood vessels, is pressed against the bones inflicting a contusion and rupture of the muscle fibres and blood vessels. The rupture usually occurs deep in the muscle. In other cases the bleeding can occur after a large or smaller muscle rupture in the anterior thigh. The bleeding can either penetrate the muscle membrane and spread over a large area, or it can accumulate in the muscle.

Symptoms: Pain and swelling in the muscle. In some cases a hard, tender accumulation can be felt (accumulated bleeding in the muscle), in other cases a bluish discoloration of the subcutis (the bleeding has penetrated the muscle membrane and spread into the sub cutis). The pain is aggravated upon activation and stretching of the muscle.

Acute treatment: Click here.

Examination: In slight cases with only minimal tenderness and no discomfort when walking, medical examination is not necessarily required. The severity of the tenderness is, however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. Acute medical attention is necessary in cases of pronounced pain or sensory disturbance, as the bleeding can occasionally cause the pressure in the muscle compartment to increase so greatly that the blood supply and nerves can be damaged (acute compartment syndrom). The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning can be performed, as this is the most suitable examination to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury.

Treatment: The treatment primarily consists of relief and rehabilitation as with muscle rupture in the anterior thigh. In cases of large accumulated bleeding the blood accumulation can be drained under ultrasound guidance. If the bleeding is located medial (M vastus mediale) or lateral on the thigh (M vastus lateralis), the rehabilitation will usually go more quickly. If the bleeding is located in the centre of the front thigh muscle (M vastus intermedius or M rectus femoris), a longer period of rehabilitation must be expected as sudden jumping or kicking will comprise a risk of a muscle rupture in the damaged anterior thigh muscle. Some advise caution with massage to reduce the risk of myositis ossificans (formation of bony bars within the muscle). Treatment with ultrasound has generally no convincing effect.

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen (article).

Thigh bone fracture

Diagnosis: THIGH BONE FRACTURE
(FRACTURA)


Anatomy:
The femur is the only bone in the thigh. Innumerable muscles are attached to the bone.

  1. Caput femoris
  2. Collum femoris
  3. Trochanter minor
  4. Trochanter major

THIGH BONE FROM THE FRONT

Cause: Fracture of the thigh bone occurs most commonly following a heavy blow or twist. By far the majority of fractures occur in the middle section of the thigh bone. A fracture of the femoral neck (article) and stress fractures are very seldom seen in children (article).

Symptoms: Pain and swelling. It will most often be impossible for the patient to support himself on the leg due to pain.

Examination: X-ray examination will usually reveal the fracture. Since many stress fractures are not visible early in the course, x-ray examination can be repeated after a few weeks. Scintigraphy, CT, MRI and ultrasound scans can often diagnose stress fractures far earlier than x-rays (Ultrasonic image). The occurrence of stress fractures in the thigh bone is very rare in children, but much more frequent in adults (see thigh stress fracture in SportNetDoc adults).

Treatment: The treatment primarily comprises relief (article). Only in special cases is surgery necessary (article).

Rehabilitation of children and adolescents: The rehabilitation is completely dependant on the severity of the fracture and the treatment. All rehabilitation should therefore be performed in close cooperation with the doctor controlling the treatment. A period of at least two months is usually recommended before full participation in sport can be permitted.

Complications: The great majority of cases heal without complication or after-effects following non-operative treatment. Complications are more frequently seen following surgical treatment of the fracture (article). A shortening of the leg can be seen following a thigh bone fracture (article) and problems in the healing process where in some cases a false joint is formed (pseudoarthrosis), which requires surgical treatment.