Athletes often face the problem of thigh muscle strain, which is treated by traumatologists. Most often, such an injury occurs when performing lunges, leg swings, and squats. If after performing the exercise a sharp pain appears, and such pain that it becomes impossible to perform it again, then this is a sprain. But you shouldn’t panic and worry ahead of time, if you carry out all the therapeutic manipulations at once, then you can quickly lead an active lifestyle again. If you turn to the anatomy and look at the cause of the pain, then the situation is as follows. There are three muscle groups in the thigh area: 1. The posterior muscles of the thigh 2. The adductor muscle of the thigh on the inside 3. The quadriceps muscle
The adductor muscle adducts the thigh, the other two are responsible for straightening and bending the legs. Because the quadriceps and hamstrings pass through the hip and knee joints, they are more susceptible to injury than others. In addition, these muscles are constantly exposed to heavy loads, especially during active physical movements, when running or fast walking, when jumping high and long, during sports games (volleyball, basketball, football). You can tear or stretch the muscles of the back or thighs with different strengths, there are 3 degrees: 1 Severe pain is felt, but there are no bruises; 2 There is severe pain and there are bruises. 3 The muscle is completely torn, many large hematomas.
In the latter case, it may even take several months to return to your previous physical shape. {banner_st-d-1}
Symptoms of a Thigh Strain
To diagnose a muscle strain in the arm or the back of the thigh, you need to know some symptoms: Firstly, there is an immediate sensation of a certain “click”; Secondly, severe pain is felt, it is painful to touch the site of injury; Thirdly, bruises can be visually seen, sometimes large bruises. After an injury, it is very difficult to continue to move, and even more so to engage in active sports. In the future, there is a greater chance of repeatedly receiving the same injury, so it is especially important to follow all instructions from the doctor and trainer. Further diagnostics are carried out by a surgeon or traumatologist. The doctor must find out under what circumstances and during what movement the injury occurred, determine the nature of the patient’s pain when pressing, as well as the size of the bruises. The doctor asks you to bend and straighten the leg at the knee and hip joints, after which he makes a diagnosis. It is necessary to take into account these symptoms of a thigh muscle strain and additionally conduct radiography.
Causes and mechanism of rupture
A rupture of the distal biceps tendon is usually traumatic in nature. This injury occurs predominantly in men, as they are more likely to lift heavy objects and undergo intense physical activity.
In older people, a rupture of the head of the biceps tendon can occur for no apparent reason. This is due to age-related changes in the tendons and the consequences of microtraumas that have occurred throughout life. But the pathology often occurs in young, active men 35-40 years old. Predisposing factors are tendinitis resulting from constant microtrauma.
Professional sports and some activities that place constant stress on the biceps muscle over time make the anatomical structures vulnerable, and they rupture even with moderate force.
The injury usually occurs during sudden lifting of weight, as well as during sudden forced extension of the elbow joint. The tendon most often ruptures in the area of attachment to the scapula, the glenohumeral joint, or near the intertubercular groove.
Treatment of thigh muscle strain
Next begins the most important stage – treatment. Usually everything happens according to the same scheme, which the doctor must tell. This is a treatment for muscle strains of the 1st and 2nd degree:
1. Maintain complete rest. It is indicated because the sore muscle cannot be loaded for any time. If the doctor, after examining the patient, deems it necessary, he may prescribe the patient bed rest, or recommend the use of crutches or a cane when moving (walking);
2. Ice wrapped in a soft towel should be applied to the area of the tear several times a day. Keep ice on the injury site for no longer than 20 minutes;
3. You should either put a special stocking on the damaged thigh or bandage it with a special bandage. This is done so that bleeding does not start under the skin, and swelling does not appear;
4. Often the injured hip should be placed at a height at the level of the patient's heart. This helps reduce or completely eliminate swelling; If the patient experiences very severe pain, the doctor will definitely prescribe him a course of anti-inflammatory drugs. Sometimes the doctor prescribes painkillers to the patient. After the swelling goes away from the hip and the patient stops feeling pain, he will need to restore the damaged muscle. For this purpose, the patient will have to engage in physical exercise of a therapeutic nature, and will also have to attend physiotherapy procedures. These actions will help restore all physical activity of the muscle in the shortest possible time. {banner_st-d-2}
Quadriceps tendon rupture
When choosing treatment tactics, we take into account the following factors:
- Nature and extent of the rupture
- Your activity level
- Your age
Conservative treatment
Very small partial tears respond well to conservative treatment.
Immobilization . Your doctor may recommend wearing an immobilizer or brace. In this case, the knee joint will be fixed in the extension position for the entire period of healing of the tendon. To limit the weight on your leg, you will most likely be advised to use crutches. Immobilization periods usually range from 3 to 6 weeks.
Physiotherapy . Once the pain and swelling have subsided, you will be prescribed physical therapy, which includes specific exercises aimed at restoring muscle strength and movement in the knee joint.
The rehabilitation program will gradually expand. The main part of the rehabilitation program most often consists of exercises related to raising the leg straightened at the knee joint. After some time, the hinges of your brace will be unlocked and you will begin to perform exercises aimed at restoring movement. As the tendon heals, the nature of the exercises will become more difficult and the load will increase.
Surgery
Most patients with complete quadriceps tendon tears require surgery to restore normal knee function. The doctor may also recommend surgical treatment for sufficiently significant partial or degenerative tendon ruptures. Treatment usually depends on the patient's age and level of physical activity.
The operation involves refixing the tendon to the patella. The earlier such an operation is performed, the better the result. As the duration of surgical treatment increases, the tendon contracts and becomes shorter.
Hospital treatment . Tendon sutures are sometimes performed on an outpatient basis, but most patients remain in the hospital for at least one day after such surgery. Whether this is true or not in your particular case is determined by medical indications.
The operation can be performed under regional (spinal) anesthesia, where only the lower half of your body is “frozen,” or under general anesthesia.
Operation technique . To restore the tendon, its end is sutured and these threads are passed through the bone canals formed in the upper pole of the patella. The sutures are then tied, restoring normal tension on the tendon and normal position of the patella.
To refix the patellar tendon, small bone canals are formed in its upper pole ( left ), through which sutures are passed to fix the tendon to the patella ( right ).
Modern techniques . Currently, suture anchors (anchors) are most often used to refix the quadriceps tendon. These are small metal or polymer implants with strong threads. Their use eliminates the need to form bone canals in the patella. The anchor is screwed into the patella and the threads are passed through the quadriceps tendon. After tying the knots, the tendon is pulled and fixed to the patella. The use of this technology has improved treatment results.
Additional stabilization methods . To further protect the tendon suture, some surgeons find it necessary to further stabilize the patella while the tendon heals with wire sutures. In such cases, you may need additional surgery to remove the suture wire.
Your surgeon will discuss with you the possible need for this additional protection. Sometimes such decisions are made during surgery. This usually happens in cases where the surgeon sees that the tendon is damaged more than expected, or if the tear is more extensive.
If the tendon is severely shortened at the time of surgery, refixing it to the patella may be very difficult or impossible. In such cases, plastic surgery is possible to lengthen the tendon. Tendon shortening usually occurs when a month or more has passed since the injury. Severe tendon injury or underlying disease can also cause the tendon to shorten. The surgeon will definitely discuss this development with you before the operation.
Complications . The most common complications of a quadriceps tendon suture are decreased quadriceps strength and limited knee motion. Sometimes re-rupture may occur. In addition, the position of the patella may change from what it was before the injury.
As with other operations, this may also include infectious complications, problems with surgical wound healing, deep vein thrombosis, or anesthetic complications.
Treatment[edit | edit code]
Conservative treatment[edit | edit code]
Most avulsion fractures and muscle avulsions are treated conservatively. The patient is advised not to put any weight on the leg and use crutches to relieve pain when walking. At first, you can use analgesics and cold compresses. Gradually begin stretching exercises until pain appears. As the pain goes away, increase the load on the affected leg, gradually introducing first static (isometric), then dynamic (isotonic) exercises, and over time, completely restore mobility in it.
Surgical treatment[edit | edit code]
Numerous works have been published specifically devoted to the treatment of avulsion fractures in children and adolescents. The authors agree that most fractures can be treated conservatively, however, if the bone fragment is displaced by more than 2 cm, especially if it is a fragment of the ischial tuberosity, the question of surgery should be raised. During the operation, immersion osteosynthesis is performed, fixing the fragment to the ischium with two screws.
Muscle avulsions in adults are also initially treated conservatively. One important exception is hamstring avulsions: surgical fixation of the tendon to the ischium has been shown to be preferable to conservative treatment.
Muscle tears[edit | edit code]
Main features[edit | edit code]
- Muscle avulsions in adults occur at the level of tendon attachment to the bone.
- Children and adolescents often experience avulsion fractures instead of muscle avulsions.
- Avulsions most commonly occur in the ischial tuberosity, iliac crest, superior or inferior anterior iliac spine, pubis, and greater or lesser trochanter of the femur.
- The cause of avulsion is usually due to too strong muscle contraction.
- Treatment of most avulsions is conservative.
Prevention[edit | edit code]
It is possible that warming up, which prepares the muscle for high loads, to some extent protects the athlete from muscle avulsions and avulsion fractures, but there is no convincing evidence of this yet.
Treatment
Treatment for a rupture of the head of the biceps can be conservative or surgical.
Tactics are determined depending on the degree of damage and the individual characteristics of the patient.
Conservative therapy
Conservative treatment is indicated in the following cases:
- middle and old age;
- contraindications to surgery;
- activities not related to the use of physical force;
- minor tendon damage.
After conservative therapy, the strength of supination is reduced by 20%, if the patient does not engage in activities associated with heavy load on the upper limbs, this factor does not affect the quality of life and allows one to fully take care of oneself.
Surgery
Surgical treatment is indicated for young people, patients who play sports or do physical work. The operation completely restores range of motion and muscle strength. The most progressive treatment method for biceps tendon rupture is such a modern surgical treatment method as arthroscopy.
The technique is based on the use of an arthroscope, which is inserted through small punctures, allowing you to examine the area of damage in detail using optics, as well as carry out the necessary manipulations to restore the tendon.
The effectiveness of the procedure is high, and the recovery period is minimal. In some cases, a technique with traditional surgical access through an incision is also used.
Rice. 4 Schematic representation of tenodesis (fixation to the head of the humerus) of the tendon of the long head of the biceps muscle with a screw (a) and an anchor fixation (b).
Description
A biceps tendon rupture can be partial or complete.
A partial tear is a tear that does not completely break the tendon. A complete tear is a tear that divides the tendon into two parts.
In many cases, tendon rupture begins with small tears in the tendon. As the process progresses, the tendon ruptures completely, sometimes when lifting a heavy object.
The long head of the biceps is more often injured. This is because it is more susceptible to injury as it runs along the shoulder joint to its insertion point on the labrum of the glenoid. Fortunately, the biceps has two attachment points to the shoulder. The short head of the biceps is rarely torn. Thanks to the presence of a second attachment point, many people can continue to use the muscle even after tearing its long head.
When your biceps tendon tears, it can also cause damage to other parts of your shoulder, such as the rotator cuff.