Chapter 21: The Thigh, Hip, Groin, and Pelvis Anatomy of the Pelvis, Thigh, and Hip Bony Anatomy ¢â‚¬¢Pelvic

  • View
    2

  • Download
    0

Embed Size (px)

Text of Chapter 21: The Thigh, Hip, Groin, and Pelvis Anatomy of the Pelvis, Thigh, and Hip Bony Anatomy...

  • Chapter 17: The Thigh, Hip,

    Groin, and Pelvis

  • Anatomy of the Pelvis, Thigh,

    and Hip

  • Bony Anatomy

    • Pelvic Girdle

    – Ilium

    • Iliac crest

    • Anterior superior iliac spine

    • Posterior superior iliac spine

    • Anterior inferior iliac spine

  • • Ischium

    – Ischial tuberosity

    – Hamstring or bursa problems

    – Should sit on this area of pelvis

    • Pubis

    – Pubic symphysis

    • Acetabulum

  • • Femur

    – Head

    – Neck

    – Greater trochanter

    – Lesser trochanter

    – Shaft

    – Medial condyle

    – Lateral condyle

  • Ligaments - Major source of strength

    – Ligamentum teres-head of femur

    – Iliofemoral ligament

    • Y ligament

    • Strongest in the body

    • Prevents hyperextension, external

    rotation, abduction

  • • Pubofemoral ligament

    – Prevents abduction

    • Ischiofemoral ligament

    – Prevents medial rotation

  • Bursa

    • 18 in hip

    • Ischial bursa

    • Greater trochanteric bursa

    – Found at attachment of gluteus

    maximus and IT band

    • Iliopsoas

  • Muscles

    • Flexors

    – Iliopsoas

    – Rectus femoris (quad)

    – Sartorius

    • Anterior thigh (quads)

    – Vastus medialis

    – Vastus lateralis

    – Vastus intermedialis

  • • Extensors

    – Gluteus maximus

    – Semitendonosis (hamstring)

    – Semimembranosis (hamstring)

    – Biceps femoris (hamstring)

    • Abductors

    – Gluteus medius

    – Gluteus minimus

    – Tensor fascia latae (Iliotibial band)

  • • Adductors

    – Adductor magnus

    – Adductor brevis

    – Adductor longus

    – Pectineus

    – Gracilis

  • • External Rotators

    – Oburator externus

    – Obturator internus

    – Quadratus femoris

    – Piriformis – sciatic nerve goes

    through it.

    – Gamellus superior

    – Gamellus inferior

    – Gluteus maximus

  • • Internal Rotators

    – Gluteus minimus

    – Tensor fascia Latae

    – Gluteus medius

  • 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?

  • • 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

  • • Special Tests

    – Thomas test

    • Test for hip

    contractures

    – Straight Leg Raise

    • Test for hip extensor

    tightness

    • Can also be used to assess

    low back or SI joint

    dysfunction

    Thomas Test

  • • Trendelenburg Test

    – Gluteus medius

    • Ober’s/Noble Test

    – IT Band

    • Fulcrum

  • 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

  • Thigh Injuries

    • Quadriceps Contusions

    – Cause of Injury

    • Constantly exposed to traumatic blows

    – Signs of Injury

    • Pain, transitory loss of function,

    immediate bleeding of affected muscles

    • Early detection and avoidance of internal

    bleeding are vital – increases recovery

    rate and prevents muscle scarring

  • Quad

    Contusion

  • • Care

    – RICE and NSAID’s

    – Crutches for more

    severe cases

    – Isometric quadriceps contractions should begin as soon as tolerated

    – Heat, massage and ultrasound to prevent myositis ossificans

    – Padding may be worn for additional protection upon return to play

  • • Myositis Ossificans Traumatica

    – 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

    • If condition is recurrent it may indicate problem with blood clotting

  • – 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)

  • • Quadriceps Muscle Strain

    – Cause of Injury

    • Sudden stretch-falls on bent knee or experiences sudden contraction

    • Weakness or over constricted muscle

    – Signs of Injury

    • Peripheral tear causes fewer sx than deeper tear

    • Pain, pt tenderness, spasm, loss of function and little discoloration

    • Complete tear may leave athlete w/ little disability/discomfort but with some deformity

  • – Care

    • RICE to control internal bleeding

    • Determine extent of injury early

    • Neoprene sleeve may provide some

    added support

  • • 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

    • Grade 2 - partial tear, identified by

    sharp snap or tear, severe pain, and

    loss of function

  • – Signs of Injury

    • Muscle belly or point of attachment

    pain

    • Capillary hemorrhage, pain, loss of

    function, and possible discoloration

    • Grade 1 - soreness during movement

    and point tenderness

  • – 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

    • Restrict activity until soreness has

    subsided

    • Ballistic stretching and explosive

    sprinting should be avoided initially

  • • Acute Femoral Fractures

    – Cause of Injury

    • Generally involves shaft, requires great

    force

    • Occurs in middle 1/3 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

  • 8 foot fall

  • • 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

    • Commonly seen in femoral neck

    – Management

    • Analgesics, NSAID’s RICE

    • ROM and PRE exercises are carried out w/ pain free ROM

  • http://images.google.com/imgres?imgurl=http://www.medscape.com/content/2001/00/40/58/405830/art-fp1401.10.fig2.jpg&imgrefurl=http://www.medscape.com/viewarticle/405830&h=460&w=400&sz=27&hl=en&start=1&tbnid=rTkv8K2kjx6jcM:&tbnh=128&tbnw=111&prev=/images%3Fq%3Dfemoral%2Bstress%2Bfracture%26gbv%3D2%26svnum%3D10%26hl%3Den

  • Hip, Groin, and Pelvic Injuries

    • Groin Strain

    – Cause of Injury

    • One of the more difficult problems to

    diagnose

    • Early part of season due to poor

    strength and flexibility

    • 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

  • • Groin Strain (continued)

    – Care

    • RICE, NSAID’s and analgesics for 48-

    72 hours

    • Determine exact muscle or muscles

    involved

    • Rest is critical

    • Restore no