Quadriceps Expansion Injection

Muscle sprain

Causes and findings:
• Overuse
• Pain usually on superior medial side of patella
• Painful: on going down hill or down stairs bresisted extension of the knee

Equipment:
Syringe - 2ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 10 mg
Lidocaine - 1.75 ml 2%
Total volume - 2 ml

Anatomy:
The quadriceps muscle inserts as an expansion around the borders of the patella. The usual site of the lesion is at the superior medial pole of the patella. This is found by pushing the patella medially with the thumb and palpating up and under the medial edge with a finger to find the tender area.

Technique:
• Patient half lies on table with knee relaxed
• Identify and mark tender area usually on medial edge of superior pole of patella
• Insert needle and angle horizontally to touch bone of patella
• Pepper solution along line of insertion

Aftercare:
Patient avoids overusing the knee for at least 1 week and, when pain free, begins progressive strengthening and stretching programme.

Comments:
This lesion, like the coronary ligament, responds very well to two or three sessions of strong deep friction. The injection is used therefore when the friction is not available, the area is too tender, or to disinflame the expansion prior to friction a week later, in a combination approach. The same technique may be used to inject inflamed plicae around the patella rim.