Hip tendonitis: causes, symptoms, diagnosis, treatment and prevention

The quadriceps muscle (quadriceps) is located on the front of the thigh and provides knee extension and hip flexion. The muscle consists of four heads, which unite and become a tendon that covers the patella. The quadriceps muscle is attached to the tibial tuberosity.

A quadriceps femoris tear is a common injury that occurs due to insufficient warming up before exercise, overuse, sudden movement, improper exercise technique, a fall or accident. The most common injury to the quadriceps femoris muscle occurs among athletes.

There are several types of quadriceps injuries:

1. quadriceps femoris strain – minor damage to muscle fibers;
2. partial rupture of the quadriceps femoris muscle - disruption of the integrity of more than 25% of the muscle fibers;
3. complete rupture of the quadriceps femoris muscle - disruption of the integrity of 100% of the muscle fibers;
4. partial or complete rupture of the quadriceps femoris tendon;
5. separation of the quadriceps femoris tendon from its insertion site;
6. degenerative injury to the quadriceps tendon.

In most cases, damage to the quadriceps femoris muscle occurs at the junction of the muscle with the tendon just above the knee joint or in the middle of the thigh in the muscle belly.

Symptoms of a quadriceps femoris tear

A characteristic symptom of a rupture of the quadriceps femoris muscle is a sharp, sharp pain at the site of injury. Stiffness of movement or inability to move the leg occurs, and swelling and hematoma gradually form.

Depending on the degree of damage to the muscle fibers, the victim may experience the following symptoms:

1. With a slight sprain, the pain is moderate, there is no hemorrhage. There may be slight discomfort when walking, and running may be difficult. Induration or spasms may appear at the site of injury.
2. With a partial rupture, movements are constrained, severe pain occurs, and extensive subcutaneous hemorrhage and swelling are formed. Pain will be felt when pressing on the suspected injury site. Straightening the knee against resistance will likely cause pain, and it will be impossible to fully bend the knee joint.
3. With a complete rupture, unbearable pain occurs, a significant hematoma forms, and the ability to move the leg completely disappears. Walking without the help of crutches is impossible.

For an injury of any severity, apply a cold compress, apply a splint and consult a specialist. The doctor will examine and palpate. At the site of the rupture, you can feel the depression in the muscle. An MRI and X-ray will be required to make a diagnosis. An MRI will show the location of the rupture and associated damage. An x-ray is necessary to ensure the integrity of the femur.

What can be seen on an x-ray?

On an x-ray of the knee joint, if the integrity of the patellar tendons of the quadriceps femoris muscle is damaged, the patella is in its place or moves slightly downward, and in case of complete damage to the patellar ligament, it moves significantly upward.

Additional data that is necessary to confirm this diagnosis can be obtained by ultrasound or MRI. These methods make it possible to track the course and integrity of tendon fibers or ligaments along their length, and in case of damage, by changing the received signal, determine the location and depth of the rupture, the amount of diastasis between the tendon fibers or ligaments.

Conservative treatment of quadriceps femoris muscle tear

Conservative treatment for rupture of the quadriceps femoris muscle is used for stretching and partial damage to muscle fibers. Complete rest, the use of a pressure bandage and cold compresses (for 20 minutes every 2-3 hours) will be recommended. Additionally, painkillers and anti-inflammatory drugs for local and external use are prescribed (Ibuprofen, Nimesil, Diclofenac, Nise, Voltaren). Cold compresses should be applied for 3 days. This will help reduce pain and eliminate swelling. Then the compresses are replaced with warming ones. Heat increases blood flow and ensures the delivery of nutrients to injured fibers.

After eliminating swelling and pain, physiotherapy is prescribed: electrophoresis with lidase, magnetic therapy, ultrasound. This accelerates the process of tissue regeneration, which promotes faster healing and muscle recovery.

Risk group

Those at high risk of developing tendinosis of the quadriceps femoris tendon are:

• people doing heavy physical work (builders, loaders);
• professional athletes (there are also some nosological forms of tendonitis, for example, “jumper’s knee” and “tennis elbow”);
• people who, due to their professional duties, systematically overload their joints (computer operators, turners, seamstresses, people working with various levers, wrenches and mechanisms);

In other situations, the main primary link in the pathogenesis of this disease may be the inflammatory process. It is in these cases that it is recommended to use the term “tendinitis”, which indicates the main cause of the pathology – inflammatory disorders in the tendons. However, tendinosis also has an inflammatory nature, but it is secondary.

Surgical treatment of quadriceps femoris muscle rupture

Surgery for a rupture of the quadriceps femoris muscle is performed for a complete rupture (always) and for a partial rupture (sometimes), which has not healed after conservative treatment. In most cases, surgery is performed under general anesthesia. After repairing the tear, an immobilizing bandage is applied to the leg for one and a half months. From the 4th week, a rehabilitation course begins, which is aimed at developing the leg and restoring muscle strength. In some cases, exercise therapy may begin in the second week after surgery. As a rule, it is possible to restore full range of motion by the 12th week. Full recovery occurs six months after the operation.

Tendinosis and tendonitis

Tendinosis, or tendonitis as it is also called, is a degenerative and dystrophic process that affects the tendons of the quadriceps femoris muscle in the places where they are attached to the bones, although secondary inflammation can reach the muscles. The name of this pathology comes from tendo - “tendons”. Theoretically, this disease can develop on any part of the body where tendons are present. However, the most common condition is quadriceps tendonitis. Disease of the shoulder and hip joints may also occur.

Rehabilitation after a quadriceps femoris rupture

Rehabilitation after a rupture of the quadriceps femoris muscle involves a course of massage and therapeutic exercises to increase elasticity and strengthen the muscle.

Muscle stretching exercises should always be painless. You should not start stretching in the first days, as this can slow down the fusion of muscle fibers (you can start these exercises no earlier than the 5th day after the injury).

Strengthening a muscle involves gradually increasing the load. These exercises can be started as early as the 3rd day if there is no pain when doing them. It is recommended to perform isometric exercises first and then move on to exercises with an elastic band. At the final stage, more functional exercises are performed, including accelerations, jerks with changes in direction of movement, and jumps.

Reasons for the development of the disease

Tendinitis is most often a reaction to various structural changes in the ligaments and tendons. This leads to a decrease in their strength, and when they are damaged, the body reacts with an inflammatory process. Experts identify a group of factors that create favorable conditions for the development of tendinitis. Namely:

• age over 40 years;
• playing sports at a professional level;
• work associated with constant loads;
• weak immunity;
• pathologies in the development of the hip joint;
• arthritis;
• metabolic disorders, especially if it concerns poor absorption of calcium;
• improper formation of the spine.

People who meet the above criteria are at risk. The main causes leading to tendonitis include:

• sudden loads. Therefore, all athletes, before starting intense training, need to warm up their muscles to improve blood circulation in the tissues. Cardio exercises or stretching are best for this;
• frequent injuries. Constant damage to the same area inevitably leads to the rapid development of inflammation;
• open wounds. Through damage to the skin, harmful microorganisms penetrate into the hip joint, causing inflammation;
• systemic diseases. Some diseases that are not directly related to the musculoskeletal system can cause tendinitis. For example, diabetes mellitus or hyperthyroidism.

Most often, it is external factors that lead to the occurrence of pathologies - inadequate physical activity or sudden movements. Among the internal causes of the disease, age-related changes in the body are most prominent.

This is due to the fact that as a person ages, the level of elastin fibers that provide elasticity to the tendons decreases. And the number of collagen fibers responsible for the rigidity and strength of tendons increases. Therefore, the hip joint becomes more vulnerable.

A set of exercises for a torn quadriceps femoris muscle

• Exercises for the hip joint after a quadriceps muscle tear
• Exercises for the knee joint after a quadriceps muscle tear

Conclusion

If pain occurs in the quadriceps femoris, it is recommended to immediately consult a doctor and stop training until complete recovery. Minor damage to the integrity of the fibers heals quickly and has no consequences. However, in order to prevent re-rupture, you should be as careful as possible when warming up before training and listen to the sensations in the muscle. Repeated tearing of the quadriceps femoris muscle leads to a loss of strength and elasticity, which reduces the functional level and affects the motor activity of the victim.

Treatment of hip tendonitis

Rheumatologists at the Yusupov Hospital carry out treatment of hip tendinitis taking into account the underlying pathology, which is the cause of inflammation of the tendons. For osteoarthritis, chondroprotectors are prescribed. Seronegative spondyloarthritis is treated with disease-modifying drugs (methotrexate, sulfasalazine). If the cause of the disease is tuberculosis, treatment with specific agents is carried out together with phthisiatricians.

Glucocorticoids are injected locally into the soft tissue surrounding the hip joint. To relieve muscle spasms, doctors prescribe muscle relaxants. The main drugs used in the treatment of hip tendonitis are non-steroidal anti-inflammatory drugs (NSAIDs):

• Diclofenac;
• Celecoxib;
• Aceclofenac;
• Ketorolac.

The analgesic and anti-inflammatory activity is associated with a decrease in the production of prostaglandins.

In the initial stages of tendonitis, patients take these drugs orally. If the pain does not go away, non-steroidal anti-inflammatory drugs are administered intramuscularly. An alternative to parenteral and oral use of NSAIDs, as well as an important auxiliary component of complex therapy for pain syndrome with hip tendinitis, is local therapy using drugs from this group.

When applied locally, NSAIDs are highly effective. They do not cause local allergic and toxic reactions to the drug. The drug is able to penetrate the skin, reaching the target tissue. The concentration of drugs in the blood serum does not reach a level that leads to side effects. Diclak gel, dolobene, relief gel are used locally.

Therapy for these pathologies

If the pathological process has acquired a chronic form, then the treatment of tendinosis/tendinitis is very long and complex - from 4 to 6 weeks. Therapy begins with conservative methods:

• complete unloading of the sore leg and immobilization (elastic bandage, plaster cast, orthosis, bandage);
• drug therapy - injections, drugs from the NSAID group, glucocorticoids;
• for infectious types of the disease, antibacterial drugs are prescribed;
• physiotherapy (laser treatment, shock wave therapy, ultrasound with hydrocortisone, magnetic therapy, electrophoresis, UHF, ozokerite and paraffin applications, etc.);
• restorative physical education.

Types of injuries

Injuries to the quadriceps muscle include:

• direct, for example, bruise as a result of a blow;
• indirect - due to excessive load, which, as a rule, damages the tendon itself in the place where it is attached to the bone, while in case of a bruise only the muscle belly suffers.

The quadriceps femoris muscle is bruised more often than any other human muscle.

Muscles work most effectively when they are warmed up. However, an overheated muscle is more susceptible to damage. Therefore, to prevent sports injuries, it is important not only to perform warming exercises, but also to maintain a relaxation regime.

With an indirect injury, a rupture can occur, in which in most cases the vastus intermedius muscle is affected. Such ruptures most often occur after the age of 30, when degenerative changes begin to occur in the tendons and less strength of the tendons is observed, and a person’s physical activity is still quite high. Complete rupture of the quadriceps tendons leads to hemarthrosis (bleeding into the knee joint).

There are also bilateral ruptures - on both hips. A similar phenomenon is possible when there are concomitant pathologies (diabetes mellitus, kidney disease, lupus erythematosus and other diseases that require steroid medications). In certain cases, rupture may occur spontaneously.

When a rupture occurs, severe pain occurs, and knee extension is difficult or impossible. In addition, at the moment of rupture, a cracking or clicking sensation may occur.

Prevention

A set of measures to prevent the development of traumatic tendonitis of the hip tendons include:

• mandatory warm-up and warm-up exercises for muscles and ligaments before each workout;
• choosing loads and types of activity that are adequate to your physical fitness;
• gradual increase in the pace and intensity of the load;
• avoiding performing monotonous exercises for a long time, changing the type of activity;
• compliance with the rest regime.

General prevention rules also include:

• timely and adequate treatment of any infectious diseases;
• compliance with the principles of healthy and rational nutrition and drinking regime;
• moderate exercise and regular physical activity to strengthen the musculoskeletal system.

Provoking factors

Tendonitis of the quadriceps femoris tendon can occur under the influence of the following diseases and conditions:

• inflammatory autoimmune pathologies (systemic connective tissue diseases, rheumatoid arthritis);
• infection of the soft tissue near the joint;
• reactive arthritis (Reiter's syndrome);
• secondary changes in other pathologies of the musculoskeletal system (osteoarthritis, poor posture, flat feet, etc.).
• allergic reactions.

In order to effectively treat tendinitis/tendinosis, it is necessary to know the background against which it arose, since treatment methods will differ significantly. For example, in the case of bacterial infection, antibiotics are prescribed, in case of autoimmune disorders - anti-inflammatory and cytostatic drugs, and in the case of professional stress, first of all, it is necessary to eliminate the provoking factors. Therefore, studying the cause is extremely important in each individual case.

Symptoms of tendinosis (tendinitis)

Clinical signs of this pathology of the quadriceps tendons are nonspecific, but make it possible to suspect the presence of a problem. The most common patient complaints are:

• pain in the area of ​​the affected joint, which occurs during certain movements (it is important to remember that passive movements do not cause pain, unlike disruption of the structures of the joint itself);
• pain when palpating the tendon;
• if the patient has ossifying tendinosis, a specific sound (crackling) may be noted during palpation and movements;
• outwardly, usually no pathological changes are observed, however, in the case of acute infectious processes, redness of the skin, swelling and an increase in local temperature may appear;
• movements in the joint are preserved, however, in case of severe pain, a person can spare the limb and avoid excessive physical activity.

A constant, and in some cases, the only symptom of tendinosis can be pain during active movements when a specific tendon is involved. Besides this, the patient may not complain about anything. Often such pain becomes a factor in the impossibility of professional activity.