Lecture # 12 Thigh, Hip and Pelvis. since the hip and pelvis have a sturdy anatomical composition, they are seldom injured in sports participation, however

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Text of Lecture # 12 Thigh, Hip and Pelvis. since the hip and pelvis have a sturdy anatomical composition,...

  • Lecture # 12Thigh , Hip and Pelvis

  • Thigh , Hip and Pelvissince the hip and pelvis have a sturdy anatomical composition, they are seldom injured in sports participation , however the soft tissue of the thigh may be frequently injuredcompressive forces may lead to contusions , which should not be serious unless they are mismanaged

  • many injuries are the result of inflexibility and muscle imbalances of the quads and hamstringsHip injuries commonly involve collision sports or forceful movements Hip and pelvic injuries more common in older active peopleApprox 1% of general active population , 5-9 % of high school , however 15 % of runners ( stress fractures to femoral neck )

  • Structure of the Hipthe femur of the thigh is a major weight bearing bone it is the longest, largest and strongest bone in the bodyits weakest component is the femoral neck the hip joint is the articulation between the concave acetabulum of the pelvis and the head of the femur

  • it is a ball and socket joint , which provides considerable stabilityligamentus teres, blood supply to the head and acetabulumstrong ligamentus support from the iliofemoral, pubofemoral and ishiofemoralplus a number of strong muscles cross the hip, enhancing its stability( RF, IP,ADDs)

  • Structure of the Pelvisthe pelvis of pelvic girdle consists of a protective bony ring formed by 4 fused bones the pelvis protects the enclosed inner organs , transmits loads between the trunk and lower extremity and provides a site for a number of major muscle attachments

  • 21-10

  • Muscular support of the Hip and PelvisFlexion- iliopsoas, rectus femoris and sartoriusExtension- glut max, hamstring, Abduction- glut med & minAdduction- pectinus, adductor brevis, longus, magnus and gracilis

  • lnt Rot- glut min, TFLExt Rot- piriformis, glut max

    Muscles of the Thigh - all muscle of the above, plus the Quads - RF, VI, VM , VL

  • Common Injuries of the Thigh, Hip and Pelvis

  • Quad ContusionsAKA Charlie horsemost common site for contusion is the antero-lateral thigh, which almost always damages muscle tissueseverity of injury is almost always underestimated and under treated l st, 2nd & 3 rd degree - depends on severity of S&S

  • s/s - immediately after impact pain and swelling may be extensive, ROM will be limited due to severityif severe the individual may not be able to bear weight and not able to fully flex the kneethere may be a palpable firm hematoma with in 24 hours resulting in the inability to contact the quads

  • First Aid Care Immediately apply ice, compression and elevate Can apply a pad, keep it in place with a elastic wrap.Have athlete rest , use crutches Athlete must get plenty of rest and time to permit healing . should be iced in a flexed positionDO NOT HEAT

  • Myositis ossificans is an abnormal ossification involving bone deposits within muscle tissue may result from a single traumatic blow or several repeated blows to the areaexamination reveals a warm, firm , swollen thigh nearly 2 to 4 cm larger than unaffected lega palpable mass may limit flexion this individual must see a physician and if mass does not reabsorb with 6 to 12 months, surgery may be necessary

  • Risk FactorsContinuing to play after injuryEarly massage or hydrotherapyPassive stretchingToo rapid of progression of therapyPremature return to play Reinjury of same area

  • Strainsmuscular strains to the thigh and hip are frequent in sports, Rectus Femoris, Adductors and hamstrings hamstrings are the most commonly strained muscle in the bodyindividual may report a snapping or tearing during an explosive action , followed by immediate pain and loss of function , with local tenderness and possibly a palpable defect

  • usually caused by rapid contraction or a violent stretchhamstring strain has the reputation of being a chronic and reoccurring problem

    Hamstring Strain

  • Risk factors Poor flexibilityPoor postureMuscle imbalanceImproper warm up Muscle fatiguePrevious injuryOveruse Improper technique

  • First Aid Care Immediately apply ice, compression and elevate Can apply a pad, keep it in place with a elastic wrap.Have athlete rest , use crutches Have athlete evaluated by medical personnel

  • Dislocated Hip Jointrare b/c of support and a wide range of motion available at the hip injury usually occurs with violent twisting or catastrophic trauma when knee is driven into a stationary object, ie the dashboard of a car

  • severe sprains or dislocations result in immediate intense pain and an inability to walk or even move the hip a dislocated hip is an emergency situation call an ambulance and stabilize Major complication is the damage to the femoral head and loss of blood supply causing avascular necrosis of the femoral head, this may lead to chronic pain , instability and eventually a total hip replacement

  • 21-33

  • First Aid Care Treat for shock Immobilize the athlete and transport to nearest medical centre, where it will be reduced Can apply a pad, keep it in place with a elastic wrap.Care should be given to monitor blood flow to rest of leg at all times .

  • Hip Pointerare contusions to the unprotected iliac crest and the muscles that insert there, generally a fall or contact with objects or equipment

  • any movement of the trunk will be painful , including coughing , laughing and breathingLocalized pain at iliac crestimmediate pain ands spasm will prevent the individual from rotating the trunk or laterally flexing protect from re-injury with a doughnut pad, when they return to play

  • First Aid Care Immediately apply ice to injured areaHave athlete rest , possibly use crutchesAvoid activity that involves bending stretching etc. Can try icing in a stretched position

  • Bursitisan inflammation of the bursafound most often in the trochanteric bursaoccurs with running ( friction between trochanter and ITB) or as a result of a contusionusually presented as a deep burning , or aching feeling Rx PIER , NSAIDS, stretching to relieve pressure

  • Piriformis SyndromeCompression or irritation of the sciatic nerveFound in runners and women especially if tight hip flexors and weak gluteals, Tight piriformis Sciatic nerve

  • s/s tight piriformis -pain in butt or down posterior legNumbness or burning in butt or down posterior leg pain with internal rotation General loss of strength of hip General treatment , lots of rest , stretching and strengthening

  • First Aid Care Can try icing Stretch of glutes Refer to therapist for attention