Transcript Thigh, Hip and Pelvis

Thigh, Hip and Pelvis
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Joints are rarely injured in sport
Soft tissue is commonly injured
Bony Structure
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Femur
Pelvis
Sacrum and Coccyx
Pelvis
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Iliac Crest
ASIS and PSIS
Ischial tuberosity
Innominate Bone- Consist of:
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Ilium
Ischium
Pubis
Hip Joint
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Ball and Socket Joint
Head of the femur- Convex
Acetabulum of the pelvis- Concave
Highly Stable from a bony perspective; several very
strong ligaments that aid in keeping the head of femur
in the acetabulum
Bursae
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Iliopsoas bursa
Deep trochanteric bursa
Nerves and Blood Supply
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Nerve supply
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Lumbar plexus (L1 – L4) - forms the femoral nerve
Sacral Plexus (L4 – S4) – forms the sciatic nerve
Blood supply
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Femoral artery
Muscles and Movements
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Hip flexion
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Normal ROM
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80 degrees knee straight
120 degrees knee bent bent
Iliacus and psoas major (major flexors)- both form the
illiopsoas- knee bent
Rectus femoris (function when knee is extended and with
kicking the ball)
Sartorius
Hip Extension
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Normal ROM 10 – 20 degrees
Hamstrings, gluteus maximus
Muscles and Movements (2)
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Abduction
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Normal ROM
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45 degrees
Gluteus medius
Adduction
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Normal ROM
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30 degrees
Adductor magnus, longus, brevis, and gracilis
Muscles and Movements (3)
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Internal Rotation or Medial Rotation
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Normal ROM
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45 degrees
Glueteus Minimus and Tensor Fascia Latae
External Rotation or Lateral Rotation
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Normal ROM
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45 degrees
6 deep external rotators- piriformis
Quadriceps Contusions
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MOI: direct blow
HOPS
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Pain, swelling and ecchymosis
Walk with a limp
Palpable hematoma, with heat
Tx
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Ice in stretched position, crutches if needed, wrap,
See field strategy 10.2 (pg. 352), refer for x-ray
Myositis Ossificans
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Accumulation of mineral deposits (bone) in muscle
tissue
MOI: Single severe blow, repeated blows to muscle,
mismanagement of contusion
HOPS
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Firm swollen area in muscle
Palpable mass
Limited knee flexion
Active contraction of muscle difficult
Tx
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Refer to physician (surgery may be needed)
Hip Pointer
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Contusion caused by direct compression to the iliac
crest
MOI: Direct blow
Hops
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Pn with rotation, trunk flexion
Ecchymosis, pain, swelling,
Point tender over illiac crest
TX
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RICE, refer for x-ray, donut pad and hard outer shell, to protect
Bursitis
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Most common = trochanteric bursitis
MOI: overuse
HOPS:
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Deep achy pain in lateral thigh
Pn with resisted abduction
TX
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Heat, stretch abductors, Ultrasound
If condition does not resolve: refer to physician
Hip Sprains/ Dislocations
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MOI: violent twisting/ severe trauma; rare in
sports
HOPS: S/S  with degree and type
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Intense pain,
Inability to walk or move hip
Hip flexed and internally rotated – Fig 10-12
TX
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Symptomatic with mild to moderate sprains
Medical emergency, summon EMS, check distal
neurovascular status; treat for shock
Muscle Strains
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Hamstring strains more probable than
Quadriceps strains; Adductor strains are more
common than Abductor
Hamstring Strains are most common
Precursors
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muscle imbalances, tight muscles, improper warmup, overuse, fatigue, dynamic overload
Muscle Strains (2)
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HOPS-In isolated region in question
– “twinge” or “pull”
– Weakness on RROM testing
– Limping; Ecchymosis
– Pop is heard when severe; Palpable defect
– Pain with passive stretch, and resistive motion
– Treatment- Hip Flexor or Hip Adductor Wrap; RICE,
E-Stim, Strengthening/Stretching, NSAID’s;
crutches if necessary
Muscle Strength Testing
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5 (normal) full strength against resistance
4 (good) partial strength against resistance
3 (fair) ability to move the body part no
resistance
2 (poor) able to contract muscle
1 (trace) no evidence of contractility
Legg-Calve-Perthes Disease
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Avascular necrosis (decreased blood supply to the
head of femur) of the proximal femoral epiphysis-Fig
10-13
Precursors: young males 3-8 years old
HOPS:
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Gradual onset of pain in hip/groin or knee with no explanation
Gradual onset of a limp;
Decreased range of motion in the hip- AB, EX, ER
TX: refer to physician if unexplained hip, thigh or knee
pain last for more than a week.
Avulsion Fractures (1)
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Precursors:
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Individuals who perform rapid acceleration/
deceleration
Locations:
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ASIS: Sartorius
AIIS: Rectus Femoris
Ischial tuberosity: hamstrings
Avulsion Fractures (2)
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HOPS
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Sudden acute localized pain
Pain, swelling, discoloration over area
Pain with resisted stretching of the involved muscle
TX
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Hip Spica Wrap if able
Fit for crutches
Refer to physician
Slipped Femoral Epiphysis
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Epiphyseal/ Growth Plate fracture- Fig 10-15
Precursor: Adolescent boys ages 8 – 15, obese
or slender rapidly growing boys
HOPS:
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Painful limp
Pain in the groin, anterior thigh or knee
Unable to internally rotate femur
Unable to stand on injured leg
TX: Refer to physician, surgery
Stress Fractures
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Precursor: Box 10-3
Common locations
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HOPS
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Pubis
Femoral neck
Proximal 1/3 of femur
Aching pain in groin or thigh during WB
Pn relieved by rest
Night pain
TX: Refer to physician
RROM testing
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Hip Flexion
Hip Extension
Hip Abduction
Hip Adduction
Hip Internal Rotation
Hip External Rotation
Knee Extension
Knee flexion
Measuring for Leg Length
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ASIS
Medial Malleolus
Patient Position:
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Lying on table, pelvis square and balanced
Legs parallel
Heels approximately 6-8 inches apart
Special Tests
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Thomas Test = Hip flexion contractures
Kendall Test = Hip flexion contractures (Rectus
Femoris)
Straight Leg Raise=Disc Lesions or tight
hamstrings
Pelvic Rock Test=Pelvic Fracture/SI Joint
Sprain
Trendelenburg’s Test
Specialized Rehab
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SLR’s- all 4 planes
Quad Sets/Glute Sets/Ham Sets
Stretching
Strengthening
Electrical Stimulation, US, Massage