The Thigh, Hip, Groin, and Pelvis © 2007 McGraw-Hill Higher Education. All rights reserved
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- The Thigh, Hip, Groin, and Pelvis 2007 McGraw-Hill Higher
Education. All rights reserved.
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- Anatomy:
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- 2007 McGraw-Hill Higher Education. All rights reserved.
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- Assessment of the Thigh History Onset (sudden or slow?)
Previous history? Mechanism of injury? Pain description, intensity,
quality, duration, type and location? Observation Postural
symmetry? Size, deformity, swelling, discoloration? Skin color and
texture? Is athlete in obvious pain? Is the athlete willing to move
the thigh?
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- 2007 McGraw-Hill Higher Education. All rights reserved.
Palpation Soft tissue of the thigh (anterior, posterior, medial,
lateral) should be palpated for pain and tenderness Bony palpation
should also be performed to locate areas of pain/discomfort Utilize
palpation to assess body symmetry (compare bilaterally)
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- 2007 McGraw-Hill Higher Education. All rights reserved. Special
Tests Thomas test Test for hip contractures -Permanent fixation of
the hip in primary positions, with limited passive or active motion
at the hip joint. Locomotion is difficult and pain is sometimes
present when the hip is in motion. It may be caused by trauma,
infection, or poliomyelitis. Straight Leg Raise Test for hip
extensor tightness Can also be used to assess low back or SI joint
dysfunction
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- 2007 McGraw-Hill Higher Education. All rights reserved.
Prevention of Thigh Injuries Thigh must have maximum strength,
endurance, and extensibility to withstand strain Dynamic stretching
programs may aid in muscle preparation for activity Strengthen
programs can also help in preventing injuries Squats, lunges, leg
press Core strengthening
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- 2007 McGraw-Hill Higher Education. All rights reserved.
Recognition and Management of Thigh Injuries Quadriceps Contusions
Cause of Injury Direct blow to the Thigh Constantly exposed to
traumatic blows Signs of Injury Pain, transitory loss of function,
immediate bleeding of affected muscles Ecchymosis Swelling Palpable
knot Early detection and avoidance of internal bleeding are vital
increases recovery rate and prevents muscle scarring
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- Care RICE and NSAIDs Crutches for more severe cases Isometric
quadriceps contractions should begin as soon as tolerated Ice on a
stretch Padding, heat, massage and ultrasound to prevent myositis
ossificans Padding may be worn for additional protection upon
return to play
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Myositis Ossificans Cause of Injury Formation of ectopic bone
following repeated blunt trauma Signs of Injury X-ray shows calcium
deposit 2-6 weeks following injury Pain, weakness, swelling,
decreased ROM Tissue tension and point tenderness Care Treatment
must be conservative May require surgical removal if too painful
and restricts motion (after one year - remove too early and it may
come back) If condition is recurrent it may indicate problem with
blood clotting
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- Quadriceps Muscle Strain Cause of Injury Sudden stretch when
athlete falls on bent knee or experiences sudden contraction
Associated with weakened or over constricted muscle Signs of Injury
Superficial tear causes fewer symptoms than deeper tear Pain, point
tenderness, spasm, loss of function and little discoloration
Complete tear may leave athlete w/ little disability and discomfort
but with some deformity Palpable divot or lump/ball of muscle Care
Rest, ice and compression to control internal bleeding Determine
extent of injury early Neoprene sleeve may provide some added
support
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- 2007 McGraw-Hill Higher Education. All rights reserved.
Hamstring Muscle Strains Cause of Injury Multiple theories of
injury Hamstring and quad contract together Change in role from hip
extender to knee flexor Fatigue, posture, leg length discrepancy,
lack of flexibility, strength imbalances, etc Signs of Injury
Muscle belly or point of attachment pain Hemorrhage, pain, loss of
function and possible discoloration Grade 1 - soreness during
movement and point tenderness Grade 2 - partial tear, identified by
sharp snap or tear, severe pain, and loss of function
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- 2007 McGraw-Hill Higher Education. All rights reserved. Signs
of Injury (continued) Grade 3 - Rupturing of tendinous or muscular
tissue, involving major hemorrhage and disability, edema, loss of
function, ecchymosis, palpable mass or gap Care RICE Rehab Restrict
activity until soreness has subsided Ballistic stretching and
explosive sprinting should be avoided Lengthy return to play 6-8
weeks
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- Acute Femoral Fractures Cause of Injury Generally involving
shaft and requiring great force Occurs in middle third due to
structure and point of contact Signs of Injury Shock, pain,
swelling, deformity Must be aware of bone displacement and gross
deformity Loss of function Care Treat for shock, verify
neurovascular status, splint before moving, reduce following X-ray
Secure immediate emergency assistance and medical referral
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- Femoral Stress Fractures Cause of Injury Overuse Females who
are amenorrheic are more vulnerable to stress fx Signs of Injury
Persistent pain in thigh X-ray or bone scan will reveal fracture
Commonly seen in the femoral neck Management Analgesics, NSAIDs
RICE ROM exercises are carried out w/ pain free ROM Rest, limited
weight bearing 4-6 respectively
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Recognition and Management of Specific Hip, Groin, and Pelvic
Injuries Groin Strain Cause of Injury One of the more difficult
problems to diagnose Often seen early in the season due to poor
strength and flexibility Occurs from running, jumping, twisting w/
hip external rotation or severe stretch Signs of Injury Sudden
twinge or tearing during active movement Produce pain, weakness,
and internal hemorrhaging Point tenderness
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- 2007 McGraw-Hill Higher Education. All rights reserved. Groin
Strain (continued) Care RICE, NSAIDs and analgesics for 48-72 hours
Determine exact muscle or muscles involved Rest is critical Restore
normal ROM and strength -- provide support w/ wrap Refer to
physician if severe groin pain is experienced
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- 2007 McGraw-Hill Higher Education. All rights reserved.
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- Sprains of the Hip Joint Cause of Injury Result of violent
twist due to forceful contact Force from opponent/object or trunk
forced over planted foot in opposite direction Signs of Injury
Signs of acute injury and inability to circumduct hip Pain in hip
region, w/ hip rotation increasing pain Care X-rays or MRI should
be performed to rule out fx RICE, NSAIDs and analgesics Depending
on severity, crutches may be required ROM and PRE are delayed until
hip is pain free
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- 2007 McGraw-Hill Higher Education. All rights reserved.
Piriformis Syndrome Cause of Condition Compression of sciatic
nerve; irritation due to tightness or spasm of muscle May mimic
sciatica Signs of Injury Pain, numbness and tingling in butt may
extend below knee and into foot Pain may increase following periods
of sitting, climbing stairs, walking or running Care Stretching and
massage NSAIDs may be prescribed Cessation of aggravating
activities will be prescribed Corticosteroid injection may also be
suggested Surgery is sometimes an option as well
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- 2007 McGraw-Hill Higher Education. All rights reserved.
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- Dislocated Hip Cause of Injury Rarely occurs in sport Result of
traumatic force directed along the long axis of the femur Signs of
Injury Flexed, adducted and internally rotated hip Palpation
reveals displaced femoral head, posteriorly Serious pathology Soft
tissue, neurological damage and possible fx Care Immediate medical
care (blood and nerve supply may be compromised) Contractures may
further complicate reduction 2 weeks immobilization and crutch use
for at least one month
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- Hip Problems in Adolescent Athletes Legg Calve-Perthes Disease
(Coxa Plana) Cause of Condition Avascular necrosis of the femoral
head in child ages 4-10 Articular cartilage becomes necrotic and
flattens Signs of Condition Pain in groin that can be referred to
the abdomen or knee Limping is also typical Varying onsets and may
exhibit limited ROM
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- Legg-Calve-Perthes Disease Care Bed rest to reduce chance of
chronic condition Brace to avoid direct weight bearing Early
treatment and head may re-ossify and re-vascularize Complication If
not treated early, will result in ill-shaping and osteoarthritis in
later life
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- 2007 McGraw-Hill Higher Education. All rights reserved. Slipped
Capital Femoral Epiphysis Cause of Condition May be growth hormone
related 25% of cases are seen in both hips Epiphysis slips from
femoral head in backwards direction due to weakness in growth plate
May occur during periods of elevated growth Signs of Condition Pain
in groin that comes on over weeks or months Hip and knee pain
during passive and active motion; limitations of abduction,
flexion, medial rotation and a limp Management W/ minor slippage,
rest and non-weight bearing may prevent further slippage Major
displacement requires surgery If undetected or surgery fails severe
problems will result
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- 2007 McGraw-Hill Higher Education. All rights reserved.
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- Iliac Crest Contusion (hip pointer) Cause of Injury Contusion
of iliac crest or abdominal musculature Result of direct blow Signs
of Injury Pain, spasm, and transitory paralysis of soft structures
Decreased rotation of trunk or thigh/hip flexion due to pain Care
RICE for at least 48 hours, NSAIDs, Bed rest 1-2 days in severe
cases Referral must be made, X-ray Padding should be used upon
return to minimize chance of added injury
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- 2007 McGraw-Hill Higher Education. All rights reserved.
Osteitis Pubis Cause of Injury Seen in distance runners Repetitive
stress on pubic symphysis and adjacent muscles Signs of Injury
Chronic pain and inflammation of groin Point tenderness on pubic
tubercle Pain w/ running, sit-ups and squats Management Rest,
NSAIDs and gradual return to activity
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- 2007 McGraw-Hill Higher Education. All rights reserved. Acute
Fracture of Pelvis Cause of Injury Result of direct blow or blunt
trauma Signs of Injury Severe pain, loss of function, shock Care
Immediately treat for shock Refer to physician Seriousness of
injury dependent on extent of shock and possibility of internal
injury
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- 2007 McGraw-Hill Higher Education. All rights reserved. Stress
Fractures Cause of injury Repetitive abnormal overused forces Signs
of Injury Groin pain, w/ aching sensation in thigh that increases
w/ activity and decreases w/ rest Discomfort increases with
activity and subsides during rest Care Refer to physician for
assessment and X-ray Rest for 2-5 months
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- 2007 McGraw-Hill Higher Education. All rights reserved.
Avulsion Fractures Cause of Injury Avulsions seen in sports w/
sudden accelerations and decelerations Pulling of tendon away and
off of bony insertion Common sites include ASIS (sartorius), AIIS
(rectus femoris attachment), ischial tuberosity (hamstring Signs of
Injury Sudden localized pain w/ limited movement Pain, swelling,
point tenderness Care Rest, limited activity and graduated
exercise
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- 2007 McGraw-Hill Higher Education. All rights reserved. Pelvic
Avulsion Fracture