Anatomy & Injuries to the Thigh, Hip and Pelvis SP Sports Medicine John Hardin Instructor

Anatomy & Injuries to the Anatomy & Injuries to the Thigh, Hip and PelvisThigh, Hip and Pelvis

SP Sports MedicineSP Sports MedicineJohn HardinJohn HardinInstructorInstructor

General Information about the General Information about the pelvispelvis

This area of body is strong and stableThis area of body is strong and stable Great demand placed on this part of bodyGreat demand placed on this part of body

—”core”—”core” Functions: Functions:

support the spine & trunksupport the spine & trunk Transfer weight to lower extremitiesTransfer weight to lower extremities Place for muscle attachment of thigh and trunkPlace for muscle attachment of thigh and trunk Protect organs of pelvic regionProtect organs of pelvic region

AnatomyAnatomy

BonesBones MusclesMuscles Ligaments Ligaments

BonesBones

FemurFemur Head, neck, greater trochanter, lesser Head, neck, greater trochanter, lesser

trochanter, shaft, medial & lateral condyle trochanter, shaft, medial & lateral condyle and epicondylesand epicondyles

PelvisPelvis Ilium: iliac crest, ASIS, AIIS, PSISIlium: iliac crest, ASIS, AIIS, PSIS Ishcium: ischial tuberosityIshcium: ischial tuberosity Pubis: Pubic symphysisPubis: Pubic symphysis AcetabulumAcetabulum

Bones-the anterior femurBones-the anterior femur

The posterior femurThe posterior femur

The pelvisThe pelvis

MusclesMuscles

Hip Flexors:Hip Flexors: Iliacus & psoas major= IliopsoasIliacus & psoas major= Iliopsoas Rectus femorisRectus femoris SartoriusSartorius

Hip Extensors:Hip Extensors: Hamstrings-biceps femoris, Hamstrings-biceps femoris,

semitendinosus, semimembranosussemitendinosus, semimembranosus Gluteus maximusGluteus maximus

MusclesMuscles

Knee flexors:Knee flexors: Hamstrings, gastrocnemiusHamstrings, gastrocnemius

Knee extensors:Knee extensors: Quadriceps—rectus femoris, vastus Quadriceps—rectus femoris, vastus

lateralis, vastus medialis, vastus lateralis, vastus medialis, vastus intermediusintermedius

MusclesMuscles

MusclesMuscles

MusclesMuscles

MusclesMuscles

Hip Adductors:Hip Adductors: Adductor magnus, adductor longus, Adductor magnus, adductor longus,

adductor brevis, gracilis, pectineusadductor brevis, gracilis, pectineus Hip Abductors:Hip Abductors:

Gluteus medius, tensor fascia lataeGluteus medius, tensor fascia latae

MusclesMuscles

MusclesMuscles

MusclesMuscles

Hip Internal rotators:Hip Internal rotators: Tensor fascia latae, gluteus minimusTensor fascia latae, gluteus minimus

Hip External rotators:Hip External rotators: Gluteus maximus, gluteus medius, Gluteus maximus, gluteus medius,

piriformispiriformis

LigamentsLigaments Thickening of joint capsule allows for Thickening of joint capsule allows for

very stable jointvery stable joint IliofemoralIliofemoral IschiofemoralIschiofemoral pubofemoralpubofemoral

Ligamentum TeresLigamentum Teres Also called the round ligamentAlso called the round ligament Attaches head of femur into acetabulum Attaches head of femur into acetabulum

allowing blood supply to that areaallowing blood supply to that area

LigamentsLigaments

Preventing injuries to Preventing injuries to thigh/hipthigh/hip

Flexibility training and stretchingFlexibility training and stretching Strength trainingStrength training Proper protective equipmentProper protective equipment

Common InjuriesCommon Injuries

StrainsStrains SprainsSprains ContusionsContusions Fractures Fractures DislocationsDislocations

StrainsStrains

QuadsQuads HamstringsHamstrings Groin (adductors)Groin (adductors) Hip flexorsHip flexors GlutealsGluteals

StrainsStrains

Mxn: Mxn: sudden strong contraction of muscle(s) sudden strong contraction of muscle(s) overstretching of muscle(s)overstretching of muscle(s) Muscle strength imbalanceMuscle strength imbalance

Strains-hamstringStrains-hamstring

Strains- groinStrains- groin

StrainsStrains

S/S: pain/discomfortS/S: pain/discomfort POTPOT Bleeding causing discoloration (after Bleeding causing discoloration (after

1-2 days)1-2 days) Loss of functionLoss of function Muscle spasmMuscle spasm deformitydeformity

StrainsStrains

TX: RICETX: RICE modify/restrict activitymodify/restrict activity crutches if necessarycrutches if necessary Medical referral if necessaryMedical referral if necessary Restore normal ROM flexibility and Restore normal ROM flexibility and

strength using various modalities as strength using various modalities as neededneeded

StrainsStrains

Complications:Complications: recurrent strains due to “inelasticity recurrent strains due to “inelasticity

of scar tissue” especially at that of scar tissue” especially at that same sitesame site

Excess buildup of scar tissueExcess buildup of scar tissue

Strains-quad after the factStrains-quad after the fact

Strains-quadStrains-quad

Strains-hamstringStrains-hamstring

Strains-hamstringStrains-hamstring

Hamstring strain treatmentHamstring strain treatment

Hamstring avulsionHamstring avulsion

ContusionsContusions

QuadricepsQuadriceps Hip pointerHip pointer

Quadriceps ContusionQuadriceps Contusion

Mxn: Mxn: direct blow to relaxed thigh compressing direct blow to relaxed thigh compressing

the musculature again the femurthe musculature again the femur

Quadriceps ContusionQuadriceps Contusion

S/S: S/S: PainPain POTPOT Bleeding into the muscleBleeding into the muscle SwellingSwelling Temporary loss of functionTemporary loss of function

Quad contusionQuad contusion Tx: RICE w/ knee flexedTx: RICE w/ knee flexed Crutches if necessaryCrutches if necessary Restore normal ROM, flexibility & Restore normal ROM, flexibility &

strengthstrength UltrasoundUltrasound HeatHeat Medical referral if neededMedical referral if needed

Quad contusionQuad contusion

Complication:Complication: Myositis ossificans—formation of bony Myositis ossificans—formation of bony

tissue within the muscletissue within the muscle Very painfulVery painful Greatly restricts ROM mainly flexionGreatly restricts ROM mainly flexion

Caused by: Caused by: severe blow that is not properly cares forsevere blow that is not properly cares for Repeated blows to same areaRepeated blows to same area

Myositis OssificansMyositis Ossificans

Hip PointerHip Pointer

Mxn: Mxn: direct blow to the iliac crest and/or ASISdirect blow to the iliac crest and/or ASIS

S/S: S/S: PainPain SpasmSpasm Bleeding in the area—disclorationBleeding in the area—discloration Temporary loss of motionTemporary loss of motion

Unable to rotate trunk or flex hip without Unable to rotate trunk or flex hip without painpain

Hip PointerHip Pointer

Hip PointerHip Pointer

Tx: Tx: RICERICE Bed rest if necessaryBed rest if necessary Medical referral if necessaryMedical referral if necessary Return to activity when pain if gone and Return to activity when pain if gone and

motion is restoredmotion is restored

Fractures-AvulsionFractures-Avulsion

Most common at ASIS or Ischial Most common at ASIS or Ischial TuberosityTuberosity

Mxn: forceful contraction of muscleMxn: forceful contraction of muscle

Avulsion FracturesAvulsion Fractures

S/S: S/S: Extreme pain with movement & Extreme pain with movement &

weight bearingweight bearing POT (either over the ASIS or Ischial POT (either over the ASIS or Ischial

tub.)tub.) Bleeding/discolorationBleeding/discoloration

AvulsionAvulsion

TX: TX: Ice Ice crutchescrutches Medical referral for x-rayMedical referral for x-ray

Fractures- femurFractures- femur

Occurs most often in the shaft of the Occurs most often in the shaft of the femurfemur

Mxn: Mxn: great force-direct or indirect- placed on great force-direct or indirect- placed on

the femurthe femur

Femur FracturesFemur Fractures

S/S:S/S: PainPain POTPOT Deformity w/ thigh externally rotated, Deformity w/ thigh externally rotated,

shortenedshortened Loss of motion/functionLoss of motion/function Swelling due to internal bleedingSwelling due to internal bleeding Muscle spasmsMuscle spasms Muscle lacerationsMuscle lacerations

Femur fracturesFemur fractures

Can be life threatening—fatty tissue Can be life threatening—fatty tissue and bone marrow can get into the and bone marrow can get into the blood stream and cause a blood clotblood stream and cause a blood clot

Femur FractureFemur Fracture

Tx: Tx: Call 911Call 911 Don’t move the athleteDon’t move the athlete Hare traction splintHare traction splint Check for distal pulseCheck for distal pulse Control any external bleedingControl any external bleeding Treat for shockTreat for shock

Femur fracturesFemur fractures

Femur fracturesFemur fractures

Femoral Stress FractureFemoral Stress Fracture

Mxn: repetitive stress of the Mxn: repetitive stress of the pounding of the lower extremity pounding of the lower extremity which causes the femur to bend (one which causes the femur to bend (one side is compressed the other is side is compressed the other is stretched)stretched)

Femoral stress fractureFemoral stress fracture

S/S:S/S: POT at one specific sitePOT at one specific site Pain with activityPain with activity Pain with a compressive force at the site Pain with a compressive force at the site

(sitting on edge of table)(sitting on edge of table) Pain with activityPain with activity

Femoral Stress fractureFemoral Stress fracture

Tx: Tx: RestRest Alternate activity—non-weight bearingAlternate activity—non-weight bearing Crutches if limpingCrutches if limping Medical referral---x-rays and bone scan Medical referral---x-rays and bone scan

or--or--

Femoral stress fxFemoral stress fx

Slipped Capital Femoral Slipped Capital Femoral EpiphysisEpiphysis

Growth plate injury (epiphyseal Growth plate injury (epiphyseal fracture)fracture)

Occurs at the capital femoral Occurs at the capital femoral epiphysis (where neck joins the head epiphysis (where neck joins the head of femur)of femur)

More common in boys 10-17 yrs.More common in boys 10-17 yrs. Tall and thin Tall and thin obeseobese

Slipped Capital femoral Slipped Capital femoral epiphysisepiphysis

Mxn: Mxn: Not know but may be related to effects Not know but may be related to effects

of a growth hormoneof a growth hormone In ¼ of cases both hips are affectedIn ¼ of cases both hips are affected

Slipped---epiphysisSlipped---epiphysis S/S:S/S:

Pain in groin area that Pain in groin area that arises suddenly as a result of traumaarises suddenly as a result of trauma arises slowly over weeks or months as a arises slowly over weeks or months as a

result of prolonged stressresult of prolonged stress Early signs minimal but later get pain in Early signs minimal but later get pain in

hip and kneehip and knee Major limitations with movementMajor limitations with movement Limp when walkingLimp when walking

Slipped --- epiphysisSlipped --- epiphysis TX: TX: Minor casesMinor cases

RestRest Non-weight bearing to prevent further Non-weight bearing to prevent further

slippageslippage Medical referralMedical referral

Major casesMajor cases Surgery to repair “fracture” usually put Surgery to repair “fracture” usually put

pins into bone to keep in place and allow pins into bone to keep in place and allow for proper healingfor proper healing

Slipped---epiphysisSlipped---epiphysis Complications: Complications: If displacement goes undetected or if If displacement goes undetected or if

surgery fails to restore normal hip surgery fails to restore normal hip mechanics can have problems later in mechanics can have problems later in lifelife Bone doesn’t grow properlyBone doesn’t grow properly Head of femur doesn’t grow properlyHead of femur doesn’t grow properly Bone spursBone spurs ArthritisArthritis

SCFESCFE

SCFESCFE

SCFESCFE Pins to fixPins to fix

Legg-Calve-Perthes DiseaseLegg-Calve-Perthes Disease Disruption of blood flow to the head Disruption of blood flow to the head

of femur causing the bone tissue to of femur causing the bone tissue to die and become flatteneddie and become flattened

Occurs in children 3-12 yrsOccurs in children 3-12 yrs Occurs in boys 4 times more often Occurs in boys 4 times more often

than girlsthan girls Usually occurs in first bornUsually occurs in first born Affect usually only one hipAffect usually only one hip

LCPDLCPD

Mxn: UnknownMxn: Unknown

S/S: S/S: complaints of pain in groin, and complaints of pain in groin, and

sometimes referred pain to abdomen or sometimes referred pain to abdomen or kneeknee

Limited hip movementLimited hip movement

LCPDLCPD Tx: Tx: Medical referralMedical referral Bed rest or non-weight bearingBed rest or non-weight bearing If treated in time, the head of femur If treated in time, the head of femur

will revascularize and regain its will revascularize and regain its normal shape (the old cells that die normal shape (the old cells that die will be resorbed and new bone cells will be resorbed and new bone cells laid down to take their place) laid down to take their place)

LCPDLCPD

LCPDLCPD

Complications:Complications: If not treated early enough, the head of If not treated early enough, the head of

femur will be ill (abnormally) shaped femur will be ill (abnormally) shaped producing osteoarthritis in later lifeproducing osteoarthritis in later life

Hip DislocationHip Dislocation Rarely occurs in sportsRarely occurs in sports Most are posteriorMost are posterior

Mxn: traumatic force along the long Mxn: traumatic force along the long axis of the femur such as falling on axis of the femur such as falling on one side with the knee bent (and one side with the knee bent (and landing on that bent knee) forcing landing on that bent knee) forcing head of femur posteriorlyhead of femur posteriorly

Hip DislocationHip Dislocation

S/S: S/S: Hip in flexion, adduction, and internal Hip in flexion, adduction, and internal

rotationrotation Deformity posterior—head of femur can Deformity posterior—head of femur can

be palpated through gluteal musclebe palpated through gluteal muscle Extreme painExtreme pain Inability to move at hip jointInability to move at hip joint

HipHip DislocationDislocation

Hip DislocationHip Dislocation

Hip DislocationHip Dislocation

TX: TX: Call 911 Call 911 Don’t move athleteDon’t move athlete Splint in position you find themSplint in position you find them Treat for shockTreat for shock

Hip DislocationHip Dislocation

Complications:Complications: Tears in the vascular and nerve Tears in the vascular and nerve

structuresstructures Blood vessels to ligamentum teres may Blood vessels to ligamentum teres may

be torn (as will the ligament itself)be torn (as will the ligament itself) Sciatic nerve may be damagedSciatic nerve may be damaged

Paralysis of muscles in the areaParalysis of muscles in the area Atrophic necrosis (degeneration of Atrophic necrosis (degeneration of

femoral head)femoral head)