What is Thigh Contusion?

Overview

Thigh contusions are a common injury in contact sports that can cause prolonged disability if not treated correctly. It is often caused by a force or trauma to the thigh, which causes pain, swelling, discolouration on the thigh, and restricted leg movement.

What is thigh contusion?

A thigh contusion is simply known as an injury to your thigh muscle. It is caused by a force on the thigh muscles (quadriceps). Thigh contusion is a muscle injury common in contact sports and seen more frequently in males than in females. Examples of these sports are American football, soccer, and softball.¹

Causes of thigh contusions

A thigh contusion happens when there is a direct blow or force to your thigh (quadriceps muscle). These injuries are usually caused in sports by a direct blow, usually from another player's knee, foot or head. They may also happen in accidents.²

Thigh contusion occurs when a compressive force (trauma) applied to the quadriceps muscle is not spread evenly, and the muscle and underlying tissue are squeezed into the femur (thighbone). The myofibers (part of the muscle cell) and capillaries (a type of blood vessel) around the quadriceps rupture, and because the thigh has a large space, a large hematoma (pool of blood) develops.¹

Types of thigh contusion

There are three types of thigh contusion based on how severe it is. The severity also depends on the active knee range of motion 12 hours after injury. The three types of thigh contusion are mild contusion, moderate contusion, and severe contusion²:

• Mild contusion - there is an active knee range of motion greater than 90 degrees
• Moderate contusion - there is an active knee range of motion between 45 to 90 degrees
• Severe contusion - there is an active knee range of motion of less than 45 degrees

Anyone who suffers from a mild contusion can move their knees at an angle of 90 degrees. If it is a moderate contusion, they can move their knees between the angles of 45 to 90 degrees, and someone with a severe contusion can move their knees at an angle less than 45 degrees.

Symptoms of thigh contusions

If you have a thigh contusion, you might have the following symptoms:^2,3

• Pain at the place of impact
• Localized swelling on the thigh
• Ecchymosis at the site of trauma (discolouration of the skin due to the haemorrhage)
• Localized tenderness
• Decreased range of motion that makes it difficult to move

Diagnosis of thigh contusions

Diagnosis of thigh contusion is by an accurate patient history and physical examination. The doctor may also conduct imaging tests such as MRI (magnetic resonance imaging), ultrasound, and sometimes radiography.^1,3

During the physical examination, your doctor may evaluate your symptoms and record degrees of knee range of movement (knee flexion) on both legs, the firmness of the injured muscle, and the circumference of the thigh in both legs.¹

Ultrasound and MRI provide information on the nature of muscle injury and may help distinguish between muscle strain, contusion, or avulsion injuries. Radiographs evaluate bony injuries and help identify myositis ossificans — a delayed complication of severe muscle contusions.³

Treatment

Treatment of thigh contusion may involve the following^1,2:

• Adequate rest - Contusions usually heal on their own, and resting your thigh can help it heal faster
• Use of ice - daily applying cold on the thigh using an ice bag can help relieve pain from the contusion
• Elevation and compression of affected thigh - elevating the contused thigh at an angle and using an elastic wrap for compression or an adjustable range-of-motion brace set at 120° can help thigh contusion. Maintaining range of movement on the knee helps limit the pool of blood formed (haematoma) by controlling bleeding. Your doctor will let you stay in this posture for about 24 hours
• NSAIDs use - administering Nonsteroidal anti-inflammatory drugs (NSAIDs) in the first 48 to 72 hours of injury can help with pain. NSAIDs help reduce inflammation, which is what causes pain. Continuous use of NSAIDs affects healing. As a result, doctors recommend using NSAIDs between 3 to 7 days of injury
• Physical therapy - involves specific exercises and stretches that increase the range of motion on the knee (knee movement) and muscle firmness
• Cryotherapy - Clinicians also use cryotherapy to treat thigh contusions. Cryotherapy helps decrease oedema and pain

The average time it takes for an athlete who suffered from thigh contusion to return to sport is 3 to 4 weeks.^1,2

If your symptoms and thigh swelling don’t improve after 3 to 4 weeks, your doctor will conduct advanced imaging, such as ultrasound and MRI for further investigation.²

Complications and risks

Thigh contusions are more likely to happen to people who play high-impact contact sports, such as American football, soccer, rugby and ice hockey.^1,4

Thigh contusion may become worse and have the following complications:

Myositis ossificans

Myositis ossificans is a proliferation of bone and cartilage in a muscle previously exposed to trauma and haematoma. It is simply when a bone forms inside your muscle or other soft tissue. Myositis ossificans can lead to continued pain, swelling and decreased range of motion.²

The incidence of myositis ossificans after a muscle contusion is between 9% and 17% and has a high chance of occurring in severe cases of thigh confusion.¹

Compartment syndrome

Compartment syndrome is an increase in pressure inside a muscle. This increased pressure restricts blood flow and causes pain. Soft tissue contusions and thigh haematomas can lead to compartment syndrome, but this happens less frequently in the thigh.²

Clinical presentations of compartment syndrome are paresthesias (pins and needles), pain with passive stretching, pain out of proportion to examination, pulselessness, paleness, and muscle weakness.² A compartment pressure higher than 30 mm Hg may require surgery for relief.¹

Prevention of thigh contusions

The following may help prevent thigh contusion:^4,5

• The use of protective gear during sports, like a thigh pad that reduces the impact of trauma
• Exercise, warm-up, and stretches improve quadriceps muscle flexibility, strength, and core stability

When to seek medical attention

A thigh contusion usually heals naturally and can be treated at home by resting the affected leg, elevating it, and using ice. However, if your thigh contusion gets worse, with increased pain, increased swelling, inability to move the leg, or there is a sign of infection, you should seek medical attention immediately.

FAQs

How long does it take for a thigh contusion to heal?

The average time it takes for a thigh contusion to heal is 3 to 4 weeks, but it depends on how severe the thigh contusion is. A mild thigh contusion will heal faster than a severe contusion, which may take more than a month to completely heal.^1,2

How severe is a thigh contusion?

A thigh contusion can be severe based on the active knee range of motion (knee movement) 12 hours after injury. As a result, a thigh contusion may be mild, moderate or severe. Anyone who suffers from a mild contusion can move their knees at an angle of 90 degrees. If it is a moderate contusion, they can move their knees between the angles of 45 to 90 degrees, and someone with a severe contusion can move their knees at an angle less than 45 degrees.²

Is a thigh contusion permanent?

Usually, thigh contusions aren't permanent because they naturally heal on their own. However, if there are complications, the damage to the thigh muscle may be permanent.^1,2

Does a thigh contusion hurt?

Yes, a thigh contusion hurts. One of its characteristic symptoms is pain on the site of trauma.^1,2,3

Summary

A thigh contusion is an injury to your thigh muscle caused by a force on the thigh muscles. It is a common injury among people who play contact sports such as soccer. There are three types of thigh contusion, depending on the severity. A thigh contusion can be mild, moderate or severe.

Common symptoms of thigh contusion are pain and swelling on the thigh and a restricted active knee range of motion on that leg. Thigh contusion is diagnosed by taking an accurate patient history, physical examination, and imaging tests such as an MRI and ultrasound.

Treatment may involve resting and elevating the leg, using ice packs on the thigh, administering NSAIDs, physical therapy, and in some rare cases, surgery. Myositis ossificans and compartment syndrome are the two main complications of a thigh contusion. So always wear sports protective gear such as a thigh pad and do stretches before and after sports to reduce any chances of getting thigh contusion.