Anatomy & Injuries to the Thigh, Hip and Pelvis

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Anatomy & Injuries to the Thigh, Hip and Pelvis. SP Sports Medicine John Hardin Instructor. General Information about the pelvis. This area of body is strong and stable Great demand placed on this part of body—”core” Functions: support the spine & trunk - PowerPoint PPT Presentation

Text of Anatomy & Injuries to the Thigh, Hip and Pelvis

  • Anatomy & Injuries to the Thigh, Hip and PelvisSP Sports MedicineJohn HardinInstructor

  • General Information about the pelvisThis area of body is strong and stableGreat demand placed on this part of bodycoreFunctions: support the spine & trunkTransfer weight to lower extremitiesPlace for muscle attachment of thigh and trunkProtect organs of pelvic region

  • AnatomyBonesMusclesLigaments

  • BonesFemurHead, neck, greater trochanter, lesser trochanter, shaft, medial & lateral condyle and epicondylesPelvisIlium: iliac crest, ASIS, AIIS, PSISIshcium: ischial tuberosityPubis: Pubic symphysisAcetabulum

  • Bones-the anterior femur

  • The posterior femur

  • The pelvis

  • MusclesHip Flexors:Iliacus & psoas major= IliopsoasRectus femorisSartoriusHip Extensors:Hamstrings-biceps femoris, semitendinosus, semimembranosusGluteus maximus

  • MusclesKnee flexors:Hamstrings, gastrocnemiusKnee extensors:Quadricepsrectus femoris, vastus lateralis, vastus medialis, vastus intermedius

  • Muscles

  • Muscles

  • Muscles

  • MusclesHip Adductors:Adductor magnus, adductor longus, adductor brevis, gracilis, pectineusHip Abductors:Gluteus medius, tensor fascia latae

  • Muscles

  • Muscles

  • MusclesHip Internal rotators:Tensor fascia latae, gluteus minimusHip External rotators:Gluteus maximus, gluteus medius, piriformis

  • LigamentsThickening of joint capsule allows for very stable jointIliofemoralIschiofemoralpubofemoralLigamentum TeresAlso called the round ligamentAttaches head of femur into acetabulum allowing blood supply to that area

  • Ligaments

  • Preventing injuries to thigh/hipFlexibility training and stretchingStrength trainingProper protective equipment

  • Common InjuriesStrainsSprainsContusionsFractures Dislocations

  • StrainsQuadsHamstringsGroin (adductors)Hip flexorsGluteals

  • StrainsMxn: sudden strong contraction of muscle(s) overstretching of muscle(s)Muscle strength imbalance

  • Strains-hamstring

  • Strains- groin

  • StrainsS/S: pain/discomfortPOTBleeding causing discoloration (after 1-2 days)Loss of functionMuscle spasmdeformity

  • StrainsTX: RICEmodify/restrict activitycrutches if necessaryMedical referral if necessaryRestore normal ROM flexibility and strength using various modalities as needed

  • StrainsComplications:recurrent strains due to inelasticity of scar tissue especially at that same siteExcess buildup of scar tissue

  • Strains-quad after the fact

  • Strains-quad

  • Strains-hamstring

  • Strains-hamstring

  • Hamstring strain treatment

  • Hamstring avulsion

  • ContusionsQuadricepsHip pointer

  • Quadriceps ContusionMxn: direct blow to relaxed thigh compressing the musculature again the femur

  • Quadriceps ContusionS/S: PainPOTBleeding into the muscleSwellingTemporary loss of function

  • Quad contusionTx: RICE w/ knee flexedCrutches if necessaryRestore normal ROM, flexibility & strengthUltrasoundHeatMedical referral if needed

  • Quad contusionComplication:Myositis ossificansformation of bony tissue within the muscleVery painfulGreatly restricts ROM mainly flexionCaused by: severe blow that is not properly cares forRepeated blows to same area

  • Myositis Ossificans

  • Hip PointerMxn: direct blow to the iliac crest and/or ASIS

  • S/S: PainSpasmBleeding in the areadisclorationTemporary loss of motionUnable to rotate trunk or flex hip without pain

  • Hip Pointer

  • Hip PointerTx: RICEBed rest if necessaryMedical referral if necessaryReturn to activity when pain if gone and motion is restored

  • Fractures-AvulsionMost common at ASIS or Ischial Tuberosity

    Mxn: forceful contraction of muscle

  • Avulsion FracturesS/S: Extreme pain with movement & weight bearingPOT (either over the ASIS or Ischial tub.)Bleeding/discoloration

  • AvulsionTX: Ice crutchesMedical referral for x-ray

  • Fractures- femurOccurs most often in the shaft of the femur

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

  • Femur FracturesS/S:PainPOTDeformity w/ thigh externally rotated, shortenedLoss of motion/functionSwelling due to internal bleedingMuscle spasmsMuscle lacerations

  • Femur fracturesCan be life threateningfatty tissue and bone marrow can get into the blood stream and cause a blood clot

  • Femur FractureTx: Call 911Dont move the athleteHare traction splintCheck for distal pulseControl any external bleedingTreat for shock

  • Femur fractures

  • Femur fractures

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

  • Femoral stress fractureS/S:POT at one specific sitePain with activityPain with a compressive force at the site (sitting on edge of table)Pain with activity

  • Femoral Stress fractureTx: RestAlternate activitynon-weight bearingCrutches if limpingMedical referral---x-rays and bone scan or--

  • Femoral stress fx

  • Slipped Capital Femoral EpiphysisGrowth plate injury (epiphyseal fracture)Occurs at the capital femoral epiphysis (where neck joins the head of femur)More common in boys 10-17 yrs.Tall and thin obese

  • Slipped Capital femoral epiphysisMxn: Not know but may be related to effects of a growth hormoneIn of cases both hips are affected

  • Slipped---epiphysisS/S:Pain in groin area that arises suddenly as a result of traumaarises slowly over weeks or months as a result of prolonged stressEarly signs minimal but later get pain in hip and kneeMajor limitations with movementLimp when walking

  • Slipped --- epiphysisTX: Minor casesRestNon-weight bearing to prevent further slippageMedical referralMajor casesSurgery to repair fracture usually put pins into bone to keep in place and allow for proper healing

  • Slipped---epiphysisComplications: If displacement goes undetected or if surgery fails to restore normal hip mechanics can have problems later in lifeBone doesnt grow properlyHead of femur doesnt grow properlyBone spursArthritis

  • SCFE

  • SCFE

  • SCFEPins to fix

  • Legg-Calve-Perthes DiseaseDisruption of blood flow to the head of femur causing the bone tissue to die and become flattenedOccurs in children 3-12 yrsOccurs in boys 4 times more often than girlsUsually occurs in first bornAffect usually only one hip

  • LCPDMxn: Unknown

    S/S: complaints of pain in groin, and sometimes referred pain to abdomen or kneeLimited hip movement

  • LCPDTx: Medical referralBed rest or non-weight bearingIf treated in time, the head of femur will revascularize and regain its normal shape (the old cells that die will be resorbed and new bone cells laid down to take their place)

  • LCPD

  • LCPDComplications:If not treated early enough, the head of femur will be ill (abnormally) shaped producing osteoarthritis in later life

  • Hip DislocationRarely occurs in sportsMost are posterior

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

  • Hip DislocationS/S: Hip in flexion, adduction, and internal rotationDeformity posteriorhead of femur can be palpated through gluteal muscleExtreme painInability to move at hip joint

  • Hip Dislocation

  • Hip Dislocation

  • Hip DislocationTX: Call 911 Dont move athleteSplint in position you find themTreat for shock

  • Hip DislocationComplications:Tears in the vascular and nerve structuresBlood vessels to ligamentum teres may be torn (as will the ligament itself)Sciatic nerve may be damagedParalysis of muscles in the areaAtrophic necrosis (degeneration of femoral head)