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Hip, Thigh, and Knee. ILIUM Acetabulum Ischium Ischial Tuberosity Pubis

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Text of Hip, Thigh, and Knee. ILIUM Acetabulum Ischium Ischial Tuberosity Pubis

  • Slide 1
  • Hip, Thigh, and Knee
  • Slide 2
  • ILIUM
  • Slide 3
  • Slide 4
  • Acetabulum
  • Slide 5
  • Ischium Ischial Tuberosity Pubis
  • Slide 6
  • Slide 7
  • Greater Trochanter Lesser Trochanter Lateral Condyle Medial Condyle
  • Slide 8
  • Lateral Condyle Patella
  • Slide 9
  • Posterior Cruciate Ligament Anterior Cruciate Ligament
  • Slide 10
  • Slide 11
  • Medial Meniscus Lateral Meniscus Medial Collateral Ligament Lateral Collateral Ligament
  • Slide 12
  • Anatomy Buttocks Gluteus Medius, Minimus, Maximus Piriformis
  • Slide 13
  • Anatomy Hip Flexors Psoas Major, Minor Iliacus
  • Slide 14
  • Anatomy Quadriceps Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius Abductor Complex Sartorius Tensor Fascia Lata Hamstrings Semimembranosus Semitendinosus Biceps femoris Adductor Complex Adductor Brevis Longus Magnus Gracilis
  • Slide 15
  • Quadriceps Rectus Femoris O: Anterior inferior iliac spine I: Patella and Tibial Tuberosity A: flexion of hip, knee extension
  • Slide 16
  • Vastus Lateralis O: greater trochanter I: lateral patella, lateral femoral condyle and rectus femoris tendon A: extension of knee
  • Slide 17
  • Quadriceps Vastus Intermedius O: proximal 2/3 of anterior femur I: inferior aspect of patella and tendons of vastus lateralis and medialis A: extension of knee
  • Slide 18
  • Vastus Medialis O: Between the Greater and Lesser Trochanter I: medial tibial condyle, medial patella and medial aspect of rectus femoris tendon A: extension of knee Vastus Medialis Oblique O: Tendon of Adductor Magnus I: Patellar Tendon/ Tibial Tuberosity A: stabilize patella
  • Slide 19
  • Slide 20
  • ABductors Sartorius O: Anterior superior iliac spine I: inferior to medial condyle of tibial A: Flexion, Abduction, and External Rotation of hip; flexion of knee, Tensor Fascia Latae O: Outer lip of iliac crest and between anterior superior and anterior inferior iliac spine I: Greater trochanter of femur, and (as iliotibial band) lateral condyle of tibia A: Abduction
  • Slide 21
  • Adductors Adductor Longus O: pubic bone I: Middle 1/3 of Femur A: adduction Brevis O: pubic bone I: proximal 1/3 of femur A: adduction Magnus O: pubic bone and ischial Tuberosity I: distal 1/3 of femur A: adduction
  • Slide 22
  • Slide 23
  • Adductors Gracilis O: pubic symphisis and pubic bone I: distal to medial tibial condyle A: adduction, flexion, and internal rotation of hip, flexion of knee; (Cross legs)
  • Slide 24
  • Iliopsoas O: Thorasic and Lumbar Vertebrae (front of spine) and Ilium I: Lesser Trochanter A: Flexion of hip
  • Slide 25
  • Hamstrings Biceps Femoris O: ischial Tuberosity I: head of fibula and lateral tibial condyle A: extension of hip; flexion of knee
  • Slide 26
  • Slide 27
  • Slide 28
  • Hamstrings Semimembranosus O: ischial Tuberosity I: medial tibial condyle A: hip extension, knee flexion Semitendinosus O: ischial Tuberosity I: medial condyle of tibia A: hip extension, knee flexion T M
  • Slide 29
  • T M
  • Slide 30
  • Gluteuses Gluteus Minimus O: Ilium I: Anterior Greater Trochanter A: Abducts and Internal Rotation Gluteus Medius O: Ilium I: Lateral Greater Trochanter A: Abduction and Internal Rotation
  • Slide 31
  • Gluteus Maximus O: Ilium Sacrum I: Posterior Greater Trochanter and IT Band A Extension and External Rotation
  • Slide 32
  • Hip/Thigh Movements Abduction Adduction Extension Flexion Internal Rotation External Rotation What muscles do these movements?
  • Slide 33
  • Palpation Hip ASIS Iliac Crests PSIS Greater Trochanter Soft Tissue IT Band
  • Slide 34
  • What muscles do these movements? List out the muscles that do each movement: Abduction Adduction Hip Flexion Hip Extension External Rotation
  • Slide 35
  • Observation Symmetry- hips, pelvis tilt (anterior/posterior) Lordosis or flat back Lower limb alignment Knees, patella, feet Genu Valgum/ Genu Varum Pelvic landmarks (ASIS, PSIS, iliac crest) Standing on one leg Pubic symphysis pain or drop on one side Ambulation Walking, sitting - pain will result in movement distortion
  • Slide 36
  • Observation Anteversion (A) and Retroversion (B) Think in terms of the Greater Trochanter
  • Slide 37
  • Observation Leg Length Discrepancy Anatomical Actual bone length difference Functional Rotation of pelvis Muscle tightness 1/8 inch or greater = discrepancy
  • Slide 38
  • Special Tests Fracture Range of Motion Passive Active Resistive
  • Slide 39
  • Thigh Injuries Quadriceps Contusion Mechanism Blow to quads. Symptoms Pain Swelling Bruising Loss of function Treatment RICE Ice bent position
  • Slide 40
  • The red is hemorrhaging within the compartment Increased swelling = Increased pressure = decreased healing/ function If hemorrhage gets too large will have to do a compartment release which is done by cutting the fascia to allow the expansion
  • Slide 41
  • Thigh Injuries Myositis Ossificans Myo= muscle itis = irritation oss = bone Mechanism Blow to thigh Hemorrhage hematoma Symptoms Pain - Hard bump Musc weakness- Swelling Loss of function Treatment At first can use Ultrasound Surgical Removal
  • Slide 42
  • Quad Compression Wrap Start slightly above patella Begin just like all other ACE wrapping techniques. Continue up the thigh halfway overlapping alternating angling up and angling down. Practice it!
  • Slide 43
  • Thigh Injuries Hamstring Strain Mechanism Overloading of HS muscles Over stretching Symptoms Pain- swelling- G2 or 3 = palpate deformity Loss of function- popping Treatment RIC ROM stretching Compression wrap same as Quad Contusion
  • Slide 44
  • Hip Injuries Groin Strain Straining of Adductors Over stretching of the muscle Symptoms Pain in medial hip Pain referred to knee Treatment RIC- light stretching NSAIDs- Strengthening ROM exercises- Compression wrap
  • Slide 45
  • Groin wrap Start with roll on lateral side of leg Start ACE at an angle 2 times around with dog ear Apply extra tension going medially as to pull the leg into ADduction. Continue your spica until out of wrap. - Athlete should fee leg being pulled in and slightly forward. ****Anytime doing a hip wrap you will pull in the direction that the injured muscles does.
  • Slide 46
  • Hip Flexor Strain Rectus Femoris/ Iliopsoas Strain -Often due to explosive activities (sprinting) -Symptoms -Pop- Loss of function -Pain -Treatment -Light stretches- rest -Compression wrap pulling forward -strengthening
  • Slide 47
  • Hip Special Tests Kendall / Thomas test Positioning Athlete lies supine with of femur off the table Test Athlete hugs opposite knee to chest Positive Knee Extends = Rectus Femoris tightness Hip Flexes = Hip Flexor Contracture
  • Slide 48
  • Slide 49
  • Hip Injuries Contusion (Hip Pointer) Mechanism Blow to iliac Symptoms Bruising Pain Loss of function Treatment RICE
  • Slide 50
  • IT Band IT Band Tendonitis Mechanism Repetitive friction over greater trochanter or lateral femoral condyle Pes cavus, Genu varum Symptoms pain at greater trochanter or lateral femoral condyle Positive Ober and Nobles tests Treatment Stretch tendon- Ice Strengthen Abductors- Rest
  • Slide 51
  • IT Band Tightness Nobles Test Position athlete supine athletes knee is flexed to 90 degrees Test Pressure is applied to lateral femoral condyle while knee is extended Positive Pain at lateral femoral condyle IT Band Tendinitis
  • Slide 52
  • IT Band Tightness Obers Position Athlete is lying on side opposite of affected side Tester is behind the athlete at the hip Test Tester holds ankle and knee (flexed to 90) Tester allows knee to adduct. Positive Pain or tightness No drop of the knee
  • Slide 53
  • Gluteus Medius and Adductor Weakness Trendelenburg Position Patient stands with feet together Test Tester stands behind the athlete Athlete lifts knee as to march Positive Drop in the non weight bearing side PSIS/ Iliac Crest *Weakness in these muscle groups can lead to IT band tendonitis, bursitis, and other hip problems.
  • Slide 54
  • Hip Injuries Trochanteric Bursitis Cause Excessive repetitive irritation at Greater Trochanter Symptoms Hip instability Snapping sensation Pain/ inability to walk Treatment ICE- Stretching NSAIDs- Strengthening Ultrasound (not the kind you see a baby with) Compression wrap Special Test - Range of Motion reproduces the pain
  • Slide 55
  • Hip Injuries Dislocated Hip Mechanism Result of traumatic force Signs and Symptoms Flexed, adducted and internally rotated hip Palpation reveals displaced femoral head posteriorly Other Soft tissue, neurological damage and possible fx Sp

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