This document discusses MRI imaging of injuries to the quadriceps muscle complex (QMC). It reviews 66 vastus muscle injuries over 7 years. Injuries were most common in the vastus lateralis, medialis, and intermedius muscles. Most injuries were grade 1 or 2 strains located in the proximal or distal thirds of the muscles. Injuries often involved multiple vastus muscles. MRI findings correlated with return to play time, with grade 1 injuries returning around 17 days on average. Differential diagnoses for quadriceps injuries include contusions, hematomas, and soft tissue masses. Prognosis is generally excellent, though complications like myositis ossificans may occur.
3. • Strains centred mainly at
musculotendinous
junction
• Bi-articular muscles
• Fast twitch (II) fibres
• Tendon involvement
poor prognostic indicator
– Comin J, et al. Return to competitive play
after hamstring injuries involving disruption
of the central tendon. Am J Sports Med.
2013 Jan;41(1):111-5
INTRODUCTION
6. INTRODUCTION
• Type I (slow twitch
fibres)
• Similar to soleus vs
gastrocnemius
• Low gear muscles
• Slower generation of
forces
Less susceptible to
strain
7. VASTUS LATERALIS
• Largest
• Most powerful of all
quadriceps
• Origin:
– Intertrochanteric line
– Anterior border greater
trochanter
– Upper half lateral linea
aspera
– (glut max, SHBF)
8. VASTUS MEDIALIS
• Origin:
– Anteromedial
intertrochanteric line
– Pectineal line
– Medial linea aspera
– Medial supracondylar
ridge
9. VASTUS INTERMEDIUS
• Origin with vastus
medialis
• Origin:
– Anterolateral femoral
shaft
– Lower part lateral
intermuscular septum
• Deepest & middle most
muscle, thus hardest to
stretch once maximal
knee flexion is attained
44. DDx
• DOMS
• Contusion
• Fat necrosis
• Haematoma
• Myositis ossificans
• Seroma/pseudocyst
• Ozçakar L, et al. Rectus muscle strain akin to a mass lesion of the thigh: sonography
distinguishes the nuance. Am J Phys Med Rehabil. 2009 Sep;88(9):780.
• Temple HT, et al. Rectus femoris muscle tear appearing as a pseudotumor. Am J Sports
Med. 1998 Jul-Aug;26(4):544-8
• Morrel-Lavalee lesion
45. DDx
• Soft tissue masses
– benign mesenchymal lesions
– sarcoma
• Acute compartment syndrome
– Burns BJ, et al. Acute compartment syndrome of the anterior thigh following quadriceps
strain in a footballer. Br J Sports Med. 2004 Apr;38(2):218-20.
• Chronic compartment syndrome
– Orava S, et al. Chronic compartment syndrome of the quadriceps femoris muscle in athletes.
Diagnosis, imaging and treatment with fasciotomy. Ann Chir Gynaecol. 1998;87(1):53-8.
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74.
75. CONCLUSION
• Vastus injuries
relatively common
– Roughly equally
divided amongst the
three heads
• Morphology reverse
of the hamstring
muscle compartment
• Distribution of injuries
reflective of anatomy
– Myofascial proximally
– Intramuscular mid
aspect
– MTJ distally