What can mean when the tendon of the quadriceps muscle of the thigh hurts? The extensor apparatus of the knee joints (tendons, patella and their ligaments) are damaged due to sharp strains of the thigh muscles or from direct injuries when bumps or falls on one or both knees.
Types of damage
Damage to the tendons of the quadriceps femoris is divided into open (violation of their integrity due to injury by a variety of sharp objects) and tears under the skin, which, in turn, according to the mechanism of their occurrence, can be divided into direct and indirect.
Depending on the time that has passed since the moment of such damage, fresh (up to six weeks) and chronic ruptures (more than six weeks) are distinguished.
Symptoms
On the front surface of the thigh and in the knee joint there are pains, instability of the injured limb, which, as it were, gives way as a result of loss of function of this muscle of the thigh. Active extension of the knee joint with a similar pathology is impossible. When pressing with your fingers along the extensor apparatus, you can feel a lowering or lowering of the patella (especially with strong tension of the quadriceps muscle).
What is visible on x-ray?
On the radiograph of the knee joint, when the integrity of the knee tendons of the quadriceps femoris is broken, the patella is in place or slightly moves down, and in the case of complete damage to the ligament of the patella, it moves significantly up.
Additional data that are necessary to confirm this diagnosis can be obtained by ultrasound or MRI. About these techniques, you can track the progress and integrity of the tendon fibers or ligaments along their length, and if damaged, by changing the received signal, establish the location and depth of the gap, the amount of diastasis between the tendon fibers or ligaments.
Tendinosis and tendonitis
Tendinosis or, as it is also called, tendonitis is a degenerative and dystrophic process that affects the tendon of the quadriceps femoris in the places where they attach 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 there are tendons. However, tendonitis of the tendon of the quadriceps femoris is most often. Shoulder and hip joint disease may also occur.
Causes
The main cause of this ailment of the tendons of the quadriceps femoris is their excessive functional load. Due to the constant increased physical activity in any part of the body, which is associated with the type of professional activity of people or with a passion for sports, microtraumas begin to develop in tendons.
If the load on the limb is stopped during this period, then such injuries can be cured quite quickly and without a trace, without causing the patient any particular inconvenience or pain.
However, in cases where damage to the tendon of the quadriceps femoris is repeated regularly, the body does not have time to heal the injuries, as a result of which an aseptic inflammatory process begins to develop in this place. Over time, there is a violation of the normal structure of tendons, their degeneration develops, which gradually leads to the loss of the basic qualities - strength and elasticity. As a result of movement, a sore foot causes pain to a person. At the same time, the functions of the affected joint also suffer.
Risk group
A high risk of tendinosis of the tendon of the quadriceps femoris is:
- people engaged in heavy types of physical work (builders, movers);
- professional athletes (there are also some nosological forms of tendonitis, for example, “jumper’s knee” and “tennis player’s elbow”);
- people who, due to professional duties, systematically overload the joints (computer operators, turners, seamstresses, people working with various levers, a wrench and mechanisms);
In other situations, the main primary link in the pathogenesis of the occurrence of this disease may be the inflammatory process. It is in these cases that the term "tendonitis" is recommended, which indicates the main cause of the pathology - inflammatory disorders in the tendons. However, tendinosis also has an inflammatory nature, however, it is already secondary.
Provocative factors
Tendonitis of the quadriceps femoris muscle may occur under the influence of the following diseases and conditions:
- inflammatory autoimmune pathologies (systemic diseases of the connective tissue, rheumatoid arthritis);
- infectious damage to the soft tissues near the joint;
- reactive arthritis (Reiter's syndrome);
- secondary changes in other pathologies of the musculoskeletal system (osteoarthritis, impaired posture, flat feet, etc.).
- allergic reactions.
In order to effectively treat tendonitis / tendinosis, you need to know the background of what it arose, since the treatment methods will be significantly different. 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 occupational stress, it is first of all necessary to eliminate the provoking factors. Therefore, the study of the cause is extremely important in each individual case.
Symptoms of tendinosis (tendonitis)
The clinical signs of this pathology of the tendons of the quadriceps femoris are nonspecific, but they make it possible to suspect the presence of a problem. The most common complaints of patients are:
- pain in the area of the diseased joint that occurs with certain movements (it is important to remember that passive movements do not cause pain, in contrast to the violation of the structures of the joint itself);
- pain when palpating a tendon;
- if the patient has ossifying teninosis, a specific sound (crackling) may be observed during palpation and movements;
- externally, usually no pathological changes are observed, however, in case of acute infectious processes, redness of the skin, its swelling and an increase in local temperature may appear;
- movements in the joint remain, however, with severe pain, a person can spare the limb and avoid excessive motor activity.
A constant, and in some cases the only symptom of tendinosis, may be pain during active movements involving a specific tendon. In addition, the patient may not complain about anything. Often such pain becomes a factor in the impossibility of professional activity.
Therapy of these pathologies
If the pathological process has acquired a chronic form, then the treatment of tendinosis / tendonitis is very long and complicated - 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;
- with infectious varieties of the disease, antibacterial drugs are prescribed;
- physiotherapy (laser treatment, shock wave therapy, ultrasound with hydrocortisone, magnetotherapy, electrophoresis, UHF, ozocerite and paraffin applications, etc.);
- rehabilitation physical education.
Calcification of the quadriceps tendon
In the quadriceps muscle, ossification and calcification are sometimes found, the cause of the development of which is still unclear. They can not be associated with either progressive or traumatic myositis, or with other diseases and disorders of innervation. Such ossifications appear to be formed formations with a distinct bone structure. The pathological process proceeds asymptomatically and is detected during x-ray examination, often - by chance or in the study of palpable seals.
In medical practice, such calcifications and ossifications were found in the brachial muscles and their tendons, in the tendons of the triceps, pear-shaped pelvis, thigh, in the ridge, in the trochanteric ulcer, at the apex of the greater trochanter, etc. In some cases, these ossifications should be classified as independent supernatural bone elements. Massive lime deposits are less common.
Bone formation in the quadriceps muscle of the thigh also remains unknown by pathogenesis and etiology. It refers to the local form of ossifying myositis, and its occurrence is not associated either with injuries or with any other diseases.
When conducting an X-ray examination, bone formation in the muscles is determined from the knee joint to the buttocks, which appears in a branched, thick form in the muscles extending from the femur, has the form of proliferation of the periosteum. The bone surface from which such bone formation originates is substantially deformed.
With ossification of the patellar ligaments in the knee joints, a symmetrical bilateral ossification of the patellar ligaments, which developed independently, is determined. The cause of such ossifications remains unclear. By design and structure, they can be represented as skeletal options. Similar asymptomatic findings are often found in the ileal ligament, when examining the cervical vertebrae and brachial muscles, in the tendon of the triceps muscle, the quadriceps muscle of the thigh.
Quadriceps tears
Tendon ruptures of the quadriceps femoris muscle can occur due to injuries, and can be spontaneous, without a specific cause. Rupture occurs, as a rule, at the site of binding of the tendon to the patella, or at the place of transition of the muscles into the tendons. They can be complete, which require surgical intervention and incomplete, which are treated conservatively.
The strength of the extension of the knee joint is provided due to the quadriceps muscle, which refers to the anterior group of femoral muscles. It consists of four muscle heads, which in the lower part merge with each other and form one common tendon, which captures the patella. Below the patella tendon of the quadriceps, the thighs continue in the form of strong ligaments, which are attached to the tibia.
Injury to this muscle is considered one of the most common injuries. Almost 95% of sports injuries are sprains, bruises, and muscle breaks.
Types of injuries
Quadriceps injuries are:
- direct, for example, contusion as a result of an impact;
- indirect - due to excessive load, in which, as a rule, the tendon itself is damaged in the place where it is attached to the bone, while only the abdomen of muscles suffers with a bruise.
The quadriceps femoris receives bruises more often than all other human muscles.
Muscles work most efficiently when they are warmed up. However, overheated muscle is more susceptible to damage. Therefore, for the prevention of sports injuries, it is important not only to perform warming exercises, but also to observe a relaxation regimen.
In indirect injury, a rupture can occur, in which in most cases the broad intermediate muscle of the thigh suffers. Such breaks are most common after the age of 30, when degenerative changes begin to occur in the tendons and less tendon strength is observed, and the physical activity of a person is still quite high. A complete rupture of the quadriceps tendon leads to hemarthrosis (hemorrhage in the knee joint).
There are also bilateral gaps - on both hips. A similar phenomenon is possible in the case when there are concomitant pathologies (diabetes, kidney disease, lupus erythematosus and other diseases that require the use of steroid medications). In certain cases, rupture can occur spontaneously.
With a rupture, severe pain occurs, and knee extension is difficult or impossible. In addition, at the time of tearing, a sensation of crackling or clicking may appear.
Tendon quadriceps tendon treatment
An incomplete rupture is successfully treated conservatively and medically. The leg is immobilized for 3-6 weeks. This is followed by rehabilitation exercises that restore the amplitude of movements. On the first day after receiving a tendon stretch of the quadriceps femoris muscle or any other injury, it is recommended to apply cold dressings to the site of localization.
With a complete rupture, surgical intervention is required, during which the tendon is sewn back to the patella. The operation should be performed as soon as possible, since the muscle after the gap can be significantly reduced and it will be impossible to restore its length.