Transcript Injuries to the Hip and Pelvis

Injuries to the Hip and Pelvis
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We will discuss a basic overview of the anatomy in the
region of the hip and pelvis
We will have a brief description of movements by the joints
and actions of the musculature in the area
We will target more common hip and pelvis injuries incurred
in sports and outlines emergency procedures
We will also talk about injuries that aren’t common in sports
The chapter reviews injuries to the male genitalia, including
both testicular contusion and torsion
It also covers hernia and nerve problems and discusses
proper referral
http://www.youtube.com/watch?v=7VpS0T_kt2w
http://www.nbcolympics.com/video/gracie-gold-confidentafter-outstanding-performance-team-event?ctx=olympicjourney
Anatomy Review…
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The hip and pelvis
form a square in the
way they are
constructed
This area comprises
the two large,
irregularly shaped
pelvic bones on the
lateral sides, the
sacrum and coccyx
posteriorly, and the
articulation of the
pubic bones anteriorly
Anatomy Review…
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The pelvic bones are
also known as the
innominate bones
and are made up
three distinct parts:
◦ The ilium
◦ The ischium
◦ And pubis
Anatomy Review…
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In the adult, the
three parts are fused
and come together
at a lateral point
called the
acetabulum, which is
where the head of
the femur articulates
with the hip to form
the hip joint
Anatomy Review…
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The bony pelvis has several functions in
the body:
◦ The lower extremities attach here
◦ Muscle attachments are prevalent
◦ It provides substantial protection for the
entire pelvic region
Anatomy Review…
The major articulations of the bony pelvis
include the hip joint, the sacroiliac joints,
and the symphysis pubis
 The hip joint is the articulation of the
head of the femur and the acetabulum in
the hip bone; it is a true ball-and-socket
joint that is well supported by strong
ligaments
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Anatomy Review
The sacroiliac joints are formed by the
sacral bones and the iliac portion of the
hip bones
 The symphysis pubis is formed by the two
pubic bones meeting in anterior portion
of the bony pelvis
 All of these joints have strong
ligamentous support that assist in joint
stability
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Anatomy Review…
Several nerves and
blood vessels course
through the bony
pelvis
 Some of the more
important nerves
that course down
the lower extremity
are subdivisions of
the make up of the
cauda equina
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Anatomy Review…
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The spinal cord ends
at L2 level, and the
cauda equina exits the
spinal cord beginning
at L2 and proceeding
inferiorly (Gray, 1974)
Nerves exiting the
spinal cord below the
L1 level typically pass
through the bony
pelvis
Anatomy Review…
These nerves include the formation of the
lumbar plexus, the sacral plexus, the
coccygeal plexus and other individual
nerves
 Probably the most well known of these is
the sciatic nerve, which is the largest in
the body and is made up of nerve roots
L4 – S3
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Anatomy Review…
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The sciatic nerve passes
through the posterior
portion of the bony
pelvis and down the
posterior aspect of the
leg
The blood vessels of the
area include both
arteries and veins that
supply the pelvis and
lower extremities
The more well known of
these vessels include the
iliac artery and vein
Anatomy Review
Many of the muscles that
attach to the bony pelvis
are ones that move the
lower extremities
 The smaller muscles
consist of the medial and
lateral rotators of the
femur
 Some of the medial
rotators include the tensor
fasciae latae and gluetus
minimus
 These muscles are quite
active in many movements
of the lower extremity
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Anatomy Review…
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The lateral rotators of
the hip are small
muscles located deep
within the hip area
that are also quite
active in many
movements of the
lower extremity
Some of those muscles
more commonly
injured include the
piriformis
◦ Which attaches to the
anterior surface of the
sacrum and to the
greater trochanter of
the femur
Anatomy Review…
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The piriformis is a
lateral rotator of the
thigh; the sciatic
nerve runs directly
beneath the
piriformis and can be
irritated by the
overuse of this
muscle
Anatomy Review…
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Other external
rotators of the thigh
include the gemelli
(superior and
inferior), which
attach on the ischium
and run to the
greater trochanter of
the femur
Anatomy Review…
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All of these muscles are small in comparison
with the surrounding muscles, but they play
an important part in the proper functioning
of the hip and leg
Many muscles attach on the pelvis and
provide musculature for the leg, back, and
abdomen
These muscles responsible for many of the
large movements at the hip joint include
flexors, extensors, adductors, and abductors
Anatomy Review…
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The main hip flexors
include the rectus
femoris, the iliopsoas
group, the tensor
fasciae latae, and the
sartorius
The rectus femoris
attaches at the ASIS
and runs down the
front of the leg to the
common attachment
of the quadriceps
group at the patellar
tendon
Anatomy Review…
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The iliopsoas group is a combination of the
iliacus and psoas muscles, which attach on the
anterior lumbar spine and iliac crest and come
together as they run down to the lesser
trochanter of the femur
Anatomy Review…
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The tensor fasciae latae
and sartorius attach on
the anterior iliac spine
The tensor fasciae latae
runs to the lateraly
condyle of the tibia,
whereas the sartoris
runs across the anterior
thigh and attaches to the
anterior medial aspect of
the tibia
The sartorius becomes
one of the muscles of
the pes anserinus group
Anatomy Review…
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The main muscles of
hip extension are the
gluteals and the
hamstrings
The gluteus maximus
is the main hip
extensor of the
gluteals
Attaches on the
posterior surface of
the ilium and runs
inferiorly to the femur
Anatomy Review…
The hamstrings attach mainly on the ischial tuberosity;
then, two of the muscles, the semitendinosus and
semimembranosus, run more medially on the posterior
leg and attach near the sartorius and on the
posterior/medial condyle of the tibia
 The biceps femoris runs more laterally on the posterior
leg and attaches to the lateral aspect of the tibia and head
of the fibula
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Anatomy Review…
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The muscles that
adduct the hip are
located on the medial
portion of the leg are
commonly called the
groin area
Main muscles included
in this group are the
three adductors
(brevis, longus,
magnus) as well as the
pectineus and gracilis
Anatomy Review…
The adductors attach on the pubis and
run to the femur
 The pectineus also attaches at the pubis
and runs to the femur
 The gracilis attaches on the inferior
portion of the pubis and runs medially
down the leg to the anterior medial
portion of the tibia
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Anatomy Review
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The sartoris, gracilis and
the semitendinosus
compose the pes
anserinus group
Say grace before tea
◦ How to remember them in
order
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http://www.youtube.com
/watch?v=PHttidEwqz8
◦ (MMG, 2008)
Common Sports Injuries…
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The
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Sports-related injuries to the
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Injuries to the soft tissues in the region are more
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Injuries commonly involve collision sports or
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Overuse injuries may also be associated with the
hip and pelvis
Skeletal Injuries…FX of the Pelvis
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One of the most devastating injuries to the
pelvic region is the
Typically, a great deal of force is necessary to
cause a fracture of this type
 This is not a
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Still, it can occur in sports such as hockey,
pole-vaulting, or football in which there is
the possibility of
Skeletal Injuries…FX of the Pelvis
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Skeletal injuries to the
pelvis in the
adolescent population
can be extremely
serious,
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Any suspected skeletal
injury to this area
should be referred to a
physician as quickly as
possible
Skeletal Injuries…FX of the Pelvis
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S&S:
◦ Abdominal pain in the
◦ There might be swelling
at the site,
◦ Pain is elicited when the
◦ Associated injuries to
internal organs such as
the bladder are possible
and should be ruled out
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TX:
◦ Treat for possible shock
and internal bleeding
◦ Monitor the athlete’s
vital signs regularly
◦ Transport the athlete to
the hospital on a long
spine board with the
Skeletal Injuries…FX of the pelvis
A fracture of the pelvis is a serious injury
and
 Treatment depends on the severity of the
injury and should be complete before the
athlete returns to practice or competition
 Under
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return to competition before seeing a
physician
Femoral Neck Stress Fracture
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This injury occurs
more commonly in the
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The femoral neck
stress fracture is a
result of a loss in
shock-absorbing
capacity of the fatigued
muscles in the hip area
Femoral Neck Stress Fracture
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This problem can also be a partial result of
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(Lacroix, 2000)
Typically, athletes c/o
The athlete will be able to walk but will
experience pain during ambulation
 Seeing a physician is necessary to get
radiographs
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Slipped Capital Femoral Epiphysis
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This problem occurs most commonly in
Typically, it occurs in boys who are tall and
have recently experienced a rapid growth
period, or in boys who are overweight
 The boy exhibits a flexed hip, thigh or knee
 Any child younger than the age of 12 who
complains of knee pain should have a
thorough
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Hip Pointer
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Probably the most common injury to the
region is a
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Typically, with this injury the athlete
receives a direct blow to the area from an
opponent’s helmet or falls to the ground
with great force
Hip Pointer
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This can be an
extremely painful and
debilitating injury for
the athlete,
Hip Pointer
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S&S:
◦ Swelling at the site of
injury
◦ Discoloration at the site
of injury
◦ Pain and discomfort at
the site of injury
◦ The athlete may walk
with a slight limp on the
affected side
 Coughing,
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TX:
◦ Immediately apply ice to
the injured area
◦ Have the
◦ If the injury is severe,
walking with crutches
may be necessary for a
few days
Hip Pointer
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Long-term care for this type of injury is
rather simple
The contusion has in most cases caused
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The muscular attachments
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The player will usually be able to participate
on a limited basis within 1 to 2 weeks,
depending on the severity
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Hip Pointer
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It is important to note that if an athlete
wishes to continue participation in sports
while recovering from a hip pointer,
Other Hip Problems
Athletes who participate in excessive running as a
part of their sport can experience what is known
as “
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 Snapping hip syndrome is a
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Usually, there is little if any pain associated with
snapping hip
 This problem is attributed to one of the
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Other Hip Problems…
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The structures that could be involved
include the
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There could be
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that induce extra movement of the
femur during locomotion
Typically, treatment consist of stretching
tightened muscles that may contribute to
Anti-inflammatory medications may help
Other Hip Problems…
Trochanteric bursitis is another rare
problem experienced by some athletes
 It is a problem seen most often
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This bursitis is usually a result of either
acute trauma to the specific area or
repeated
Other Hip Problems..
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The
and the athlete continues to run when
he/she is experiencing S&S of trochanteric
bursitis
 When an athlete is experiencing the
onset of trochanteric bursitis,
Other Hip Problems..
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Most athletes benefit from
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For some athletes, it may be necessary to
pad the area if there is a chance of external
trauma such as falling or being hit by another
athlete in the hip
On rare occurrences,
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http://www.youtube.com/watch?v=ZDBLdEp
svvk
Osteitis Pubis
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Another type of skeletal injury to the
pelvic area is
This injury is commonly a result of
overuse and chronic strain on the joint
 Long-distance runners, basketball and
soccer players, and
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Osteitis Pubis
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Athletes who produce
during their sport participation are
more susceptible to this problem
 Osteitis pubis is a difficult injury to
diagnose because the many muscles and
structures in the pelvic area,
Osteitis Pubis
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S&S
◦ c/o an insidious onset
of pain that worsens
progressively
◦ May
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TX:
◦ Should be referred to
the appropriate
doctor for complete
evaluation
◦ Because this is a
chronic problem,
◦ Athlete may benefit
from RICES
Osteitis Pubis
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The athlete typically responds well to
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An athlete may take anywhere from 3
months to a year to return to preinjury
functioning levels
Injury of the Sacroiliac Joint…
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The sacroiliac (SI)
joint, which is the
articulation between
the sacrum and pelvis,
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Movement of this joint
is limited because of
the
Injury of the Sacroiliac Joint…
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This joint can present problems for the
athlete if it becomes
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Injuries resulting in an immobile SI joint
require specific
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Problems with inflammation in the SI joint
can be treated by a certified athletic trainer
or physical therapist under the direction of a
physician
Hip Dislocation…
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Infinitely
This injury is actually quite rare in athletic events;
however,
If a violent collision occurs between two players
or between a player and another object (for
example, the boards surrounding a hockey rink),
this type of injury can happen
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Most often the hip dislocates posteriorly, and the
athlete experiences extreme pain and loss of
movement in the affected extremity
Hip Dislocation
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S&S:
◦ Abnormal pain at the
site of injury
◦ Swelling at the site of
injury,
◦ Knee of the involved
extremity is angled
toward the opposite leg
◦ This injury is typically
quite visible to the
observer
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TX:
◦ Treat for possible shock
◦ Immobilize the athlete
and transport to the
nearest medical center
◦ Care
Soft-tissue Injuries…
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Because of the size and functions of the
musculature in the hip and pelvic region,
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The ligamentous support of the hip, sacrum,
and other structures in the area is very
strong; as a result, sprains rarely occur here
however, several muscles attach in the area
of the pelvis,
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Avulsion Fractures…