Thigh contusion (bruise)
A thigh contusion or muscle bruise is an injury to the soft tissue (muscle fibers, connective tissue, and/or blood vessels and nerves) of the upper leg. The most commonly involved muscle is the quadriceps. The muscle contusion may be accompanied by bone contusion (bruise) or even a fracture (broken bone). These contusions are graded 1, 2, or 3 depending on the severity.
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Grade 1 (mild): A grade 1 thigh contusion produces mild bruising, little pain and no swelling at the site of impact. The knee moves normally or very close to normally. Athletes have some mild soreness when pressure is applied to the area of injury.
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Grade 2 (moderate): This injury is slightly deep than a grade 1 contusion and produces mild pain and a little swelling. Athletes with a grade 2 muscle injury can only bend the knee part of the way and may walk with a slight limp. Pressure on the area of injury causes some pain.
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Grade 3 (severe): Severe muscle contusions are very painful and are accompanied by noticeable swelling. Individuals with this type of injury usually develop obvious bruising at the sight of injury. Severe muscle injuries result in a significant loss of motion in the knee and cause an obvious limp. Athletes have pain with pressure at the site of injury and the surrounding area.
How it occurs
Thigh contusions occur when an individual receives one or more direct blows, to the thigh, or falls or jams the thigh against a hard surface. In essence, the muscles are compressed and crushed between the object or person delivering the blow and the underlying bone.
Signs and symptoms
Signs and symptoms of muscle contusions include swelling and bruising at the injury site, muscle tightness, pain with or without movement, and inability to move the knee fully.
Diagnosis
A complete physical examination will determine the exact location and extent of the injury. Your doctor can tell you if she feels a gap within the muscle indicating a possible tear. X-rays of the femur (thigh bone), hip and/or knee are often taken to rule a fracture (broken bone) or other conditions. Additional tests such as ultrasound, CT scan, or MRI may be required to determine the extent of the injury and to identify any additional injuries. The results of the physical exam and other diagnostic tests allow your doctor to determine how severe this injury is; this is very important for guiding the treatment plan and making decisions about when it is safe for you to return to athletics.
Treatment
Initial treatment includes rest and protecting the injury from further harm by stopping play or practice. Applying ice to the thigh and elevating the leg will help minimize injury to the muscle. If putting weight on your leg is painful, you will need to use crutches to protect the injury site. Compressing the area with a soft bandage and keeping the muscle in a slightly stretched position may be beneficial as well. Anti-inflammatory medications such as ibuprofen can be used for pain relief. Once you are able to comfortably bend your knee to 90 degrees or more, your physician will prescribe a physical therapy or rehabilitation program. Massage and heat should be avoided for at least the first few days after injury. If you notice numbness and weakness developing in the foot or rapidly increasing swelling in the thigh, you should seek immediate medical attention. Although it occurs very rarely, rapid bleeding into the muscle may cause a build-up of pressure in the thigh; this may require urgent surgery to drain blood from the thigh.
Returning to activity and sports
The time to your return to activity and sports depends on the grade/severity of the injury and how you progress with stretching and strengthening exercises. Moderate to severe contusions take an average of 4 to 6 weeks to heal. Minor contusions take considerably less time. If you put too much stress on the injured area before it is healed, excessive scar tissue may develop. Your physician will allow you to return to contact sports when you get back your full strength, motion, and endurance. You may need to wear a protective device or pad to prevent further injury to the thigh.