Transcript Chapter 15 Knee Injuries

Chapter 13
Hip, Pelvis, and Thigh Injuries
The Hip, Pelvis, and Thigh



Includes some of the
strongest muscles in the
body.
Subjected to
tremendous demands.
Extremely vulnerable to
injuries that can sideline
a player for an
extensive period of
time
Anatomy of the Hip and Pelvis


The hip joint is a ball-and-socket joint that allows
motion and provides stability needed to bear
body weight
The socket area, which is inside the pelvis, is
called the acetabulum. The ball part of this joint
is the top of the leg bone (head). It joins with the
acetabulum to form the hip joint.
Anatomy of the Thigh

Bones

The femur
•
Designed to permit maximum
mobility and support during
movement
Longest and strongest bone in
the body
Extends from the hip to the
knee
The head of femur articulates
with the pelvis to form the hip
joint
•
•
•
Anatomy of the Thigh

Pelvis
 Ilium
 Ischium
 Pubis
Muscles of the Hip
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
Most powerful in
the body
Hip Flexors
Rectus femoris
 Sartorius
 Iliopsoas
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Psoas major
Psoas minor
iliacus
Muscles of the Hip

Hip Extensors
 Hamstrings
 Biceps
femoris
 Vastus lateralis
 Vastus medialis
 Gluteus
maximus
Muscles of the Hip

Abductors
Gluteus
medius
 Gluteus
minimus
 Tensor fascia
latae

Muscles of the Hip/Thigh


Medial Thigh Muscles
(Groin)
Primary function:
adduction
Gracilis
 Adductor magnus
 Adductor brevis
 Adductor longus
 Pectineus

Thigh Injuries
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Very few sprained
ligaments or
dislocations in this area
Proper flexibility and
strength prevents most
hip injuries
Proper equipment also
important
Thigh Injuries

Quadriceps Contusion
 Symptoms
 Caused
& Signs
by sharp blow to thigh
 Severe impact from relaxed thigh (muscle to femur)
 Extent of force and degree of thigh relaxation determines
depth of injury
 Feels like a muscle bruise
 Produces intense pain and weakness
 Grades 1 - 4 depending on severity of injury
Thigh Injuries
 Management
 RICE
 Use
elastic bandage for pressure and support in the
quadriceps area
 Constant stretching of quadriceps muscle
 Do not exercise if pain is still occurring
 Begin slowly with swimming, jogging, etc...
Thigh Injuries

Myositis Ossificans (bone growth in muscle)
 Symptoms
& Signs
 Pain,
muscle weakness, soreness, swelling, decreased muscle
function, ROM
 Caused by multiple blows to the muscle area
 A single severe blow
 Improper care of a contusion
 Management
 PRICE
 Do
not ignore quadriceps contusions
 Remove surgically after one year
Thigh Injuries
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Quadriceps & Hamstring Strains

Symptoms & Signs
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
Pain, discomfort, point tenderness, spasms, soreness
Grade 1 = mostly spasms, grade 3 = rupture of tendon/muscle
tissues
Strains tend to reoccur because of scar tissue that forms during the
healing process
Management
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PRICE, NSAIDS, analgesics
Cryotherapy
Preventative – stretch, warm up, use proper form
Thigh Injuries
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Stress Fractures and Femur Fractures
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Symptoms & Signs
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Stress fracture – femur bends slightly, pain and discomfort from
pounding of lower extremity (running)
Femur Fracture – severe pain, loss of function, internal bleeding,
swelling
Management for stress fracture:
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Rest
An alternative activity
-Management for femur fracture:

Immobilization, once at hospital traction splint may be used to pull
femur and reduce pain
Femur Fractures
Anatomy of the Hip and Pelvis
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Bones

Ilium
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

Pubis
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
Broad, flaring portion of
hip bone
Crest of the pelvis
Lower, posterior part of hip
bone
Ischium

Helps to form the hip
Hip injuries

Hip Pointer
 Injury
to the iliac crest
 Can be as minimal as contusion or as major as an
avulsion fracture
 Can be very painful and debilitating
Hip Injuries/Conditions

Legg-Calve-Perthes Disease
A
disruption of blood flow to the head of the femur
 The 'ball' of the 'ball and socket' joint dies
 Usually is seen in children 2 to12 years of age, five
times more common in boys than girls
 Characterized by extreme pain in groin and knee
area, or walking with limp
Hip Injuries
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Dislocation of hip – Femur pops out of the socket
(acetabulum)
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Causes
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Athletic injuries
Car accidents
Severe falls
Signs & Symptoms
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Extreme pain
Leg is often internally rotated
Possible loss of feeling in foot or leg due to nerve damage
X-Ray or position of leg usually determines this injury
Hip Injuries - Dislocation
 Management
 Call
ambulance immediately, hospital will relocate hip
 Months of rehab needed – very long process
 Begin with normal ROM and strength
 May need to learn how to walk again
Hip injuries - Snapping Hip
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The snapping hip – The IT band snaps over the greater
trochanter hip stability becomes lessened and ligaments and
adductor muscles become less stable.
- Causes
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Habitual movements that predispose muscles around the hip to become
imbalanced
Greater range of motion of hip abduction
Dancers, gymnasts, hurdlers – structurally narrow pelvic width
Signs & Symptoms
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Snapping occurs when balancing on one leg
Pain and inflammation with the snapping
Hip snapping
Hip injuries – Hip snapping
 Management
 Cryotherapy
 Ultrasound
to stretch tight muscles and strengthen weak
muscles in the hip region
 Resume activity when the pain subsides
Slipped Capital Femoral Epiphysis

The head of the femur slips off of the neck or shifts
position
Found mostly in boys between 10 -17 who are tall & thin or
obese
 May be related to the effects of a growth hormone
 Signs & Symptoms
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Pain in the groin, limping
Hip and knee pain during passive and active motion
Avascular Necrosis

Temporary or permanent loss of the blood supply
to the proximal femur.
- Causes
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
Without blood, the bone tissue dies and causes a collapse of the
joint surface.
Use of steroids can cause AVN
- Signs and Symptoms
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No symptoms in the early stages
Joint pain, at first during activity, then during rest
Osteoarthritis may develop after a period of time
Avascular Necrosis
 Management
 See
physician for an MRI, X-ray, or CT scan
 Electrical stimulation, ROM exercises, reduce weight bearing
activity
 Surgery will eventually be required to repair the joint
Groin Strains and Avulsions
Groin Strains
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Groin strains usually involve the adductor group
(especially adductor longus)
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Causes
 Running, jumping, or twisting with external rotation
 Sports that require stretching of the hip
 Rapid changes in speed or direction (soccer)
Signs & Symptoms
 Complete rupture of the muscles that attach the pelvis bone to the
femur bone.
 Pain, weakness, and internal hemorrhage
 A sudden twinge or feeling of tearing
Groin Strains
 Management
 RICE,
NSAIDs, anagelsics for 48 – 72 hours after injury
occurs
 Rest
 Daily whirlpool therapy or cryotherapy
 Ultrasound
 Gradual stretching to restore ROM
 Protective spica bandages can be worn or Sawa groin &
thigh braces
Hip, Thigh, and Groin Stretches
Hip, Thigh, and Groin Stretches