One of the largest muscles in our body is the one on the front of the thigh. It is called the Quadriceps because it has four distinct beginnings (heads) that form separate muscles (vastus medialis, vastus intermedius, vastus lateralis and rectus femoris) that come together and insert as a single unit to the superior pole of the patella wrapping it and then inserting into the anterior tibial tuberosity.

Functionally, the quadriceps contributes significantly to the knee's stability. The quadriceps is a prime mover of knee extension and assists in hip flexion. The athlete can be injured in two ways. One is by a direct blow to the muscle and a second method is when the extension movement is performed suddenly.

A direct blow can cause blood vessels to break leading to intermuscular or intramuscular hematomas.

Physical examination includes a direct palpation to the injured area that should provoke pain and limping by the patient. This diagnosis is not difficult to determine because the athlete's history leaves no doubt (figure 17).

When there is a torn muscle caused by an overexertion, the examiner can also palpate underlying edema. The athlete will usually be quite uncomfortable in the area of the injury and unable to perform an isometric contraction of the thigh similar to the unaffected leg.

We can check the range of motion of the leg with the athlete lying supine on the edge of the examination table and bending the knee to the limit of pain (figure 18). At this point, stop the

Figure 17. A visible bruise is often seen

Movement and measure the hip and knee angles. Repeat the test with the uninvolved leg and determine the difference in the measurements. Treatment should be instituted immediately to prohibit the injury from complicating and increasing the pain as time passes.

Figure 18. With the injured leg hanging from the lateral of the examination table flex the knee and measure the angle at which the pain is triggered and you can compared it to the contralateral side

Some times in the clinical history we have reports of previous ruptures that left an obvious muscle deformity (such a depression in the rectus femoris), but from the functional point of view the athlete's performance is unaffected even although the defect could be very large and might even need surgery, [8].

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