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Quadriceps muscle and tendon injuries

Timothy J Von Fange, MD
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Injuries of the quadriceps muscles and tendons are common among athletes and active adults. Most can be diagnosed by a careful history and physical examination, and conservative management is successful for the large majority.

The presentation, diagnosis, and management of quadriceps injuries are reviewed here. Other lower extremity injuries are discussed separately, including the following topics. (See "Overview of running injuries of the lower extremity" and "Hamstring muscle and tendon injuries" and "Approach to the adult with knee pain likely of musculoskeletal origin" and "Patellofemoral pain" and "Iliotibial band syndrome".)


The quadriceps muscles are composed of the rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius (picture 1 and figure 1 and figure 2 and figure 3 and figure 4). The rectus femoris lies centrally at the anterior thigh and has two origins (figure 5). More superficial fibers begin as a tendon at the anterior inferior iliac spine (AIIS), while deeper fibers arise from the acetabular rim. These two muscle sections fuse with a myofascial layer, sometimes called the central tendon, that extends two-thirds the length of the rectus femoris. The vastus lateralis muscle originates at the proximal, lateral border of the femur and the area of the greater trochanter (figure 6 and figure 7). The vastus lateralis (figure 8) has the largest volume of all of the quadriceps. It contributes to knee extension but also pulls the patella laterally. The vastus medialis is the smallest of the quadriceps and originates at the medial femur near the intertrochanteric line. The vastus medialis (figure 9) counteracts the vastus lateralis by pulling the patella medially. As a shorter muscle with less mass, the vastus medialis must maintain adequate strength to counteract the vastus lateralis. The vastus intermedius (figure 10) originates from the proximal portion of the femur at the superior intertrochanteric line (figure 11). The vastus intermedius helps to stabilize midline tracking of the patella during knee extension.

The combined action of the quadriceps can generate powerful knee extension. The muscles insert onto the patella as the common quadriceps tendon. This tendon then envelops the patella and inserts onto the tibial tuberosity. The portion of the tendon that extends inferior to the patella is generally referred to as the patella tendon.

Innervation of the quadriceps muscles is from the femoral nerve (figure 12), which arises from nerve roots at the second to fourth lumbar vertebrae (L2 to L4). The vastus lateralis and vastus medialis receive a greater portion of their innervation from the L3 nerve root.

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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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