Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Rupture of the Quadriceps or Hamstring Muscles

SYMPTOMS

Sudden sharp pain most commonly affecting the quadriceps or hamstring muscles during activity. Often the athlete falls in the middle of a stride and cannot continue.

AETIOLOGY

The tear can be partial (Grade I-II) or complete (Grade III-IV), often close to a musculo tendinous junction and occasionally at the origins. The muscle can tear from sudden excessive strain, often during an eccentric contraction such as landing from a jump or push-off in sprinting.

CLINICAL FINDINGS

There is tenderness on palpation around the rupture; sometimes there is a palpable gap in the muscle. Contraction of the muscle during a resistance test is painful and there is obvious weakness.

INVESTIGATIONS

Clinical examination is the most important tool for diagnosis and should also include tests for all ligaments and other structures in the knee. Ultrasound and MRI can be valuable to determine whether the tear is intra- or intermuscular, which is important for treatment and prognosis.

TREATMENT

Most muscle ruptures can be treated without surgery with immediate compression and ice, followed by gradual mobilisation and increased activity, guided by a rehabilitation programme, over three months. If the rupture is complete, surgery may be required. Also if the rupture and bleeding occur within its fascia, intra-muscular, surgical evacuation of the haematoma may be necessary.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for further investigations to verify the extent of the injury. Physiotherapists will be involved in close collaboration with the surgeon.

EXERCISE PRESCRIPTION

Cycling and swimming are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Muscle strength and flexibility must be up to the same standard as the non-injured leg before allowing a return to full sport. An objective test in an isokinetic machine is recommended.

DIFFERENTIAL DIAGNOSES

Tendon rupture, avulsion fracture of the origin or insertion.

PROGNOSIS

A majority of these injuries will not cause long-term problems, subject to correct initial handling to reduce bleeding, and thorough rehabilitation. In rare cases, the bleeding may turn into calcification (myositis ossificans) and fibrosis, which may trap nerves or cause other local symptoms.

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