Quadriceps Tendonitis

Introduction

Our body generally loads over the knee which is a major weight-bearing joint so it takes lots of stress as we age. Decades of stress on the joint can induce overutilization. This then causes stress, friction, and swelling of the quadriceps tendon and sometimes results in a torn tendon. This can present as an aching sensation over the knee and possibly includes swelling and reduced function of your quadriceps muscles. Causes For Quadriceps Tendonitis This overuse injury is commonly associated with sports that require constant bending and straightening of the knee such as running.

Relevant Anatomy

The quadriceps mechanism is the tendon from where the big muscle of the thigh, called as quadriceps converges. The patella is smack bang in the middle of that, it has within this a tendon that extends inferiorly from the patella and goes further down until inserts into the tibia on something known as a tubercle. The tendon is the remainder of the quadriceps mechanism in addition to the patella. Anatomically the tendon is referred to functionally as one but it consists of two different structures with an upper half, which corresponds to quadriceps tendon insertion on the patella, and a lower portion –the remaining part attaching to tibial tubercle–which corresponds to the real patellar attachment (patellar ligament), also known in first cell line anterior knee pain.

The quadriceps contracts, causing the knee to straighten. Both the leg bone(tibia) and thigh femur of the figure can act as levers with one articulating end (the transverse axis or pivot point). During the walking there are forces of up to 2-3 times body weight (foot and ankle joint reaction) with p a marathon runner which may climb up to around>5X’s this while completing running.

Causes

A cause for Quadriceps tendonitis, an overuse injury can be intrinsic or extrinsic.
Extrinsic- These are factors like using the wrong footwear, Following appropriate training protocols, and most importantly constant playing in training on hard unforgiving surfaces such as cement. Quadriceps tendonitis also can be affected by overtraining (either too long or too hard) and sudden changes in the level of training.
Predisposing factors are classified into Intrinsic are host specific factors like age, flexibility, and joint laxity. Some specific host characteristics predispose an individual area following:
Foot, ankle, and leg malalignment.
Flat foot (pes plants),
Patellar maltracking
Rotation of tibia
Leg length discrepancy
Obesity

Symptoms

Where patients usually feel the pain at the lowest part of their thigh a few cm above their kneecap. Pain at and around the tendon attachment, aggravated further by movements of the knee joint.

Sometimes the presentation may have swelling in the lower end of the thigh, Swelling is very tender to touch in some cases. Morning stiffness or symptoms on waking up from rest and prolonged immobility, as well after exercise.

Diagnosis

It is a clinical examination done after the thorough history taking. Usually, tenderness is elicited with palpation of quadriceps tendon insertion. An assessment of the knee is made with a view to a range of movements, detecting for laxity and integrity in their axial (AP/PA), coronal or sagittal planes. Intrinsic and extrinsic factors (i.e., sudden changes in training habits) affecting the knee should be ruled out by the clinician [9]. Proper alignment with the knee, foot, and ankle is also reviewed. In the case of quadriceps tendon rupture with gap can be felt at the insertion site. Weakness in the extensor mechanism is often synonymous with a dysfunction of the quadriceps.

An X-ray of the knee can demonstrate fractures or calcific deposits in the quadriceps muscle but this will not pick up soft tissue injuries. Tears, tendonitis, and tendinosis are diagnosed with high-definition Ultrasound and MRI. The utility of ultrasound even extends to the guidance for Regenerative treatments such as Platelet Rich Plasma and Prolotherapy.

Treatment

CONSERVATIVE TREATMENT

The first Effective Treatment employed would involve Rest, Ice, Elevation and anti-inflammatory Drugs.

The answer to that is relative rest… followed by some very gradual increase of activities which will enforce the physiology behind recovery. However, immobilization is the first thing to be done for a patient who has pain at rest with a splint or brace. Relative rest → a detail of the resting-to-recovery process varying in intensity according to symptoms. If the pain is at rest, then full immobilization is strict. brace or splint will be for a short duration of time. Progressive activity as such is permitted only when it will not cause a return of the resting pain.

Rehabilitation is not complete without physical therapy. Ice massage, local ultrasound application, and electrical stimulation are all modalities that help to keep the pain and inflammation under control. Stretching and strengthening are the means by which we correct those imbalances of muscle dominance. Eccentric Muscle strengthening is useful in cases where the primary cause of pain is excessive eccentric muscle loading during weight-bearing closed-chain kinetic activities. (Open Chain- foot is free from ground)