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Introduction

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As strong as my legs are, it is my mind that has made me a champion.

Michael Johnson, four times Olympic Gold Medal winner who suffered from a very publicized quadriceps strain

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The anterior thigh (Fig. 30.1) is the site of common sporting injuries such as quadriceps muscle contusion and strain of the quadriceps muscle. Referred pain from the hip, sacroiliac joint (SIJ) and lumbar spine can also cause anterior thigh pain.1 Stress fracture of the femur is an uncommon, but important diagnosis. The causes of anterior thigh pain are shown in Table 30.1.

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Figure 30.1

Anatomy of the anterior thigh

(a) Surface anatomy

Graphic Jump Location
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Table Graphic Jump Location
Table 30.1

Causes of anterior thigh pain

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Clinical approach

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History

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The two most important aspects of the history of a patient with anterior thigh pain are the exact site of the pain and the mechanism of injury. The site of the pain is usually well localized in cases of contusion or muscle strain. Contusions can occur anywhere in the quadriceps muscle but they are most common anterolaterally and in the vastus medialis obliquus. Muscle strains generally occur in the midline of the thigh anteriorly.

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The mechanism of injury may help differentiate between the two conditions. A contusion is likely to be the result of a direct blow, whereas a muscle strain usually occurs when an athlete is striving for extra speed when running or extra distance when kicking. In contact sports, however, the athlete may have difficulty recalling the exact mechanism of injury.

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Whether the athlete was able to continue activity, the present level of function, and the degree of swelling are all guides to the severity of the condition. Determine whether the RICE regimen was implemented initially and whether there were any aggravating factors (such as a continued activity). Gradual onset of poorly localized anterior thigh pain in a distance runner worsening with activity may indicate stress fracture of the femur. If the pain is variable and not clearly localized, and if specific aggravating factors ...

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