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

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  • Anatomy & Injuries to the Thigh, Hip and Pelvis SP Sports Medicine John Hardin Instructor
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  • General Information about the pelvis This area of body is strong and stable This area of body is strong and stable Great demand placed on this part of body core Great demand placed on this part of body core Functions: Functions: support the spine & trunk support the spine & trunk Transfer weight to lower extremities Transfer weight to lower extremities Place for muscle attachment of thigh and trunk Place for muscle attachment of thigh and trunk Protect organs of pelvic region Protect organs of pelvic region
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  • Anatomy Bones Bones Muscles Muscles Ligaments Ligaments
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  • Bones Femur Femur Head, neck, greater trochanter, lesser trochanter, shaft, medial & lateral condyle and epicondyles Head, neck, greater trochanter, lesser trochanter, shaft, medial & lateral condyle and epicondyles Pelvis Pelvis Ilium: iliac crest, ASIS, AIIS, PSIS Ilium: iliac crest, ASIS, AIIS, PSIS Ishcium: ischial tuberosity Ishcium: ischial tuberosity Pubis: Pubic symphysis Pubis: Pubic symphysis Acetabulum Acetabulum
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  • Bones-the anterior femur
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  • The posterior femur
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  • The pelvis
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  • Muscles Hip Flexors: Hip Flexors: Iliacus & psoas major= Iliopsoas Iliacus & psoas major= Iliopsoas Rectus femoris Rectus femoris Sartorius Sartorius Hip Extensors: Hip Extensors: Hamstrings-biceps femoris, semitendinosus, semimembranosus Hamstrings-biceps femoris, semitendinosus, semimembranosus Gluteus maximus Gluteus maximus
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  • Muscles Knee flexors: Knee flexors: Hamstrings, gastrocnemius Hamstrings, gastrocnemius Knee extensors: Knee extensors: Quadricepsrectus femoris, vastus lateralis, vastus medialis, vastus intermedius Quadricepsrectus femoris, vastus lateralis, vastus medialis, vastus intermedius
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  • Muscles
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  • Muscles
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  • Muscles
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  • Muscles Hip Adductors: Hip Adductors: Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus Hip Abductors: Hip Abductors: Gluteus medius, tensor fascia latae Gluteus medius, tensor fascia latae
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  • Muscles
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  • Muscles
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  • Muscles Hip Internal rotators: Hip Internal rotators: Tensor fascia latae, gluteus minimus Tensor fascia latae, gluteus minimus Hip External rotators: Hip External rotators: Gluteus maximus, gluteus medius, piriformis Gluteus maximus, gluteus medius, piriformis
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  • Ligaments Thickening of joint capsule allows for very stable joint Thickening of joint capsule allows for very stable joint Iliofemoral Iliofemoral Ischiofemoral Ischiofemoral pubofemoral pubofemoral Ligamentum Teres Ligamentum Teres Also called the round ligament Also called the round ligament Attaches head of femur into acetabulum allowing blood supply to that area Attaches head of femur into acetabulum allowing blood supply to that area
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  • Ligaments
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  • Preventing injuries to thigh/hip Flexibility training and stretching Flexibility training and stretching Strength training Strength training Proper protective equipment Proper protective equipment
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  • Common Injuries Strains Strains Sprains Sprains Contusions Contusions Fractures Fractures Dislocations Dislocations
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  • Strains Quads Quads Hamstrings Hamstrings Groin (adductors) Groin (adductors) Hip flexors Hip flexors Gluteals Gluteals
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  • Strains Mxn: Mxn: sudden strong contraction of muscle(s) sudden strong contraction of muscle(s) overstretching of muscle(s) overstretching of muscle(s) Muscle strength imbalance Muscle strength imbalance
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  • Strains-hamstring
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  • Strains- groin
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  • Strains S/S: pain/discomfort S/S: pain/discomfort POT POT Bleeding causing discoloration (after 1-2 days) Bleeding causing discoloration (after 1-2 days) Loss of function Loss of function Muscle spasm Muscle spasm deformity deformity
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  • Strains TX: RICE TX: RICE modify/restrict activity modify/restrict activity crutches if necessary crutches if necessary Medical referral if necessary Medical referral if necessary Restore normal ROM flexibility and strength using various modalities as needed Restore normal ROM flexibility and strength using various modalities as needed
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  • Strains Complications: Complications: recurrent strains due to inelasticity of scar tissue especially at that same site recurrent strains due to inelasticity of scar tissue especially at that same site Excess buildup of scar tissue Excess buildup of scar tissue
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  • Strains-quad after the fact
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  • Strains-quad
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  • Strains-hamstring
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  • Strains-hamstring
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  • Hamstring strain treatment
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  • Hamstring avulsion
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  • Contusions Quadriceps Quadriceps Hip pointer Hip pointer
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  • Quadriceps Contusion Mxn: Mxn: direct blow to relaxed thigh compressing the musculature again the femur direct blow to relaxed thigh compressing the musculature again the femur
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  • Quadriceps Contusion S/S: S/S: Pain Pain POT POT Bleeding into the muscle Bleeding into the muscle Swelling Swelling Temporary loss of function Temporary loss of function
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  • Quad contusion Tx: RICE w/ knee flexed Tx: RICE w/ knee flexed Crutches if necessary Crutches if necessary Restore normal ROM, flexibility & strength Restore normal ROM, flexibility & strength Ultrasound Ultrasound Heat Heat Medical referral if needed Medical referral if needed
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  • Quad contusion Complication: Complication: Myositis ossificansformation of bony tissue within the muscle Myositis ossificansformation of bony tissue within the muscle Very painful Very painful Greatly restricts ROM mainly flexion Greatly restricts ROM mainly flexion Caused by: Caused by: severe blow that is not properly cares for severe blow that is not properly cares for Repeated blows to same area Repeated blows to same area
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  • Myositis Ossificans
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  • Hip Pointer Mxn: Mxn: direct blow to the iliac crest and/or ASIS direct blow to the iliac crest and/or ASIS
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  • S/S: S/S: Pain Pain Spasm Spasm Bleeding in the areadiscloration Bleeding in the areadiscloration Temporary loss of motion Temporary loss of motion Unable to rotate trunk or flex hip without pain Unable to rotate trunk or flex hip without pain
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  • Hip Pointer
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  • Tx: Tx: RICE RICE Bed rest if necessary Bed rest if necessary Medical referral if necessary Medical referral if necessary Return to activity when pain if gone and motion is restored Return to activity when pain if gone and motion is restored
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  • Fractures-Avulsion Most common at ASIS or Ischial Tuberosity Most common at ASIS or Ischial Tuberosity Mxn: forceful contraction of muscle Mxn: forceful contraction of muscle
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  • Avulsion Fractures S/S: S/S: Extreme pain with movement & weight bearing Extreme pain with movement & weight bearing POT (either over the ASIS or Ischial tub.) POT (either over the ASIS or Ischial tub.) Bleeding/discoloration Bleeding/discoloration
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  • Avulsion TX: TX: Ice Ice crutches crutches Medical referral for x-ray Medical referral for x-ray
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  • Fractures- femur Occurs most often in the shaft of the femur Occurs most often in the shaft of the femur Mxn: Mxn: great force-direct or indirect- placed on the femur great force-direct or indirect- placed on the femur
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  • Femur Fractures S/S: S/S: Pain Pain POT POT Deformity w/ thigh externally rotated, shortened Deformity w/ thigh externally rotated, shortened Loss of motion/function Loss of motion/function Swelling due to internal bleeding Swelling due to internal bleeding Muscle spasms Muscle spasms Muscle lacerations Muscle lacerations
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  • Femur fractures Can be life threateningfatty tissue and bone marrow can get into the blood stream and cause a blood clot Can be life threateningfatty tissue and bone marrow can get into the blood stream and cause a blood clot
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  • Femur Fracture Tx: Tx: Call 911 Call 911 Dont move the athlete Dont move the athlete Hare traction splint Hare traction splint Check for distal pulse Check for distal pulse Control any external bleeding Control any external bleeding Treat for shock Treat for shock
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  • Femur frac