Quadriceps Contracture: Insights on Treatment Options

Frog legs

Hello Dr.
Su, I would like to ask you some questions.
Due to receiving injections since childhood, I have developed significant muscle contractions in both thighs (with noticeable indentations), which prevents me from squatting down properly.
The angle at which I can squat is poor, and my leg muscles are very tight.
When I attempt to squat, my thighs become very sore and painful.
I am currently considering corrective surgery and am receiving treatment and rehabilitation at Changhua Christian Hospital.
In September, I first visited the orthopedic outpatient clinic, where the orthopedic surgeon referred me to the rehabilitation department for initial rehabilitation.
I have undergone several examinations, including:
1.
Electromyography (EMG), which showed normal results with no injury to the sciatic nerve.
2.
X-ray examination revealed scoliosis, but the doctor stated it is not severe; however, I already have a herniated disc.
3.
Muscle ultrasound examination indicated fibrosis in both quadriceps, specifically between the rectus femoris and the vastus lateralis, with the rehabilitation physician noting that my case is quite rare.
Typically, frog leg syndrome is associated with gluteus maximus contractions, whereas I have quadriceps contractions, which is more unusual.
4.
I have been undergoing rehabilitation for nearly three months, but the results have not been very satisfactory.
5.
The rehabilitation physician mentioned that a consultation with the orthopedic team is necessary, and I am currently waiting for the report.
While researching online, I learned that you have considerable experience in treating frog leg syndrome.
I would like to ask if you have encountered patients with similar quadriceps issues, and what are the differences in surgical approaches between gluteus maximus contractions and quadriceps contractions?

tjd, 30~39 year old female. Ask Date: 2005/12/16

Dr. Su Yiren reply Orthopedics

Dear TJD,
According to the information you provided, it appears to be Quadriceps contracture.
This condition is relatively rare in Taiwan, but more common in mountainous areas of Japan.
In the 1960s, a significant number of cases were reported, leading to schoolchildren being unable to squat.
Initially, it was thought to be caused by adverse effects of injected medications.
However, during the post-war era when medical and health care was underdeveloped, the use of injected medications was widespread throughout Japan.
It raises the question of why cases were concentrated in Yamanashi Prefecture (Kai), with some cases also reported in Nagano and Mino.
I believe this may still be a matter of ethnicity, as similar conditions in Taiwan, such as frog legs, are also primarily found in the southwestern coastal regions.
If symptoms are severe and the patient can no longer squat, surgical intervention through quadriceps lengthening may be necessary.
However, this requires making a long incision over the knee, and the recovery period can be quite inconvenient.
There is also the question of whether the quadriceps muscle strength will fully recover in the future.
I advise everyone that unless it significantly impacts daily life, do not readily accept surgery.
051219
Yi-Jen, Su

Reply Date: 2005/12/16

More Info

Understanding quadriceps contracture, particularly in the context of your condition, is crucial for determining the most effective treatment options. Quadriceps contracture can result from various factors, including prolonged immobility, neurological conditions, or as a consequence of trauma or injury. In your case, it appears to be related to previous injections that caused muscle tightness and subsequent contracture.

Overview of Quadriceps Contracture
Quadriceps contracture is characterized by the shortening and tightening of the quadriceps muscles, which can lead to significant functional limitations, such as difficulty squatting or bending the knees. This condition can also result in pain and discomfort, particularly during activities that require knee flexion. The tightness you describe, along with the muscle fatigue and pain when attempting to squat, indicates that the quadriceps are not functioning optimally.

Diagnostic Findings
Your diagnostic tests, including electromyography (EMG) and ultrasound, have provided valuable insights. The normal EMG suggests that there is no nerve damage, which is a positive sign. The presence of fibrosis in the quadriceps muscles, particularly between the rectus femoris and vastus lateralis, indicates that there may be structural changes in the muscle tissue that contribute to the contracture. Additionally, the X-ray findings of mild scoliosis and disc protrusion may also play a role in your overall musculoskeletal health, potentially affecting your posture and biomechanics.

Treatment Options
1. Physical Therapy: It appears you have already begun physical therapy, which is often the first line of treatment for muscle contractures. A targeted rehabilitation program focusing on stretching, strengthening, and improving the range of motion is essential. Techniques such as manual therapy, ultrasound therapy, and specific stretching exercises may help alleviate tightness and improve function.

2. Surgical Intervention: If conservative measures do not yield significant improvements, surgical options may be considered. The surgical approach for quadriceps contracture can vary depending on the severity and specific characteristics of the contracture.
- Quadriceps Release: This procedure involves cutting the tight portions of the quadriceps tendon to allow for greater knee flexion. This is often performed in conjunction with rehabilitation to maximize outcomes.

- Tendon Lengthening: In cases where there is significant shortening of the muscle, tendon lengthening may be necessary to restore function.

3. Differentiating Between Muscle Groups: The surgical approach may differ between quadriceps contracture and other types of contractures, such as those involving the gluteus maximus (buttock muscles). The quadriceps contracture typically focuses on the anterior thigh, while gluteal contractures may require different techniques to address the posterior chain.

Considerations for Your Case
Given that your case is somewhat unique, with quadriceps contracture rather than the more common gluteal contracture, it is essential to work closely with both your orthopedic and rehabilitation specialists. They can provide a comprehensive treatment plan tailored to your specific needs.
Additionally, since you have been undergoing rehabilitation for three months with limited results, it may be beneficial to reassess your therapy regimen. Discuss with your rehabilitation physician the possibility of adjusting your treatment plan, incorporating more aggressive stretching techniques, or exploring alternative therapies such as aquatic therapy or neuromuscular electrical stimulation.

Conclusion
In summary, quadriceps contracture can significantly impact your mobility and quality of life. A multidisciplinary approach involving physical therapy, potential surgical intervention, and ongoing evaluation is crucial for optimizing your treatment outcomes. It is important to maintain open communication with your healthcare team to ensure that all aspects of your condition are addressed effectively. If you have further questions or concerns, do not hesitate to reach out to your healthcare providers for personalized advice and support.

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