Thigh, Hip and Pelvis

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Thigh, Hip and Pelvis. Joints are rarely injured in sport Soft tissue is commonly injured Bony Structure Femur Pelvis Sacrum and Coccyx. Pelvis. Iliac Crest ASIS and PSIS Ischial tuberosity Innominate Bone- Consist of: Ilium Ischium Pubis. Hip Joint. Ball and Socket Joint - PowerPoint PPT Presentation

Text of Thigh, Hip and Pelvis

  • Thigh, Hip and PelvisJoints are rarely injured in sportSoft tissue is commonly injuredBony StructureFemur PelvisSacrum and Coccyx

  • PelvisIliac CrestASIS and PSISIschial tuberosityInnominate Bone- Consist of:IliumIschiumPubis

  • Hip JointBall and Socket JointHead of the femur- ConvexAcetabulum of the pelvis- ConcaveHighly Stable from a bony perspective; several very strong ligaments that aid in keeping the head of femur in the acetabulumBursaeIliopsoas bursaDeep trochanteric bursa

  • Nerves and Blood SupplyNerve supplyLumbar plexus (L1 L4) - forms the femoral nerveSacral Plexus (L4 S4) forms the sciatic nerveBlood supplyFemoral artery

  • Muscles and MovementsHip flexion Normal ROM80 degrees knee straight120 degrees knee bent bentIliacus and psoas major (major flexors)- both form the illiopsoas- knee bentRectus femoris (function when knee is extended and with kicking the ball)SartoriusHip ExtensionNormal ROM 10 20 degreesHamstrings, gluteus maximus

  • Muscles and Movements (2)AbductionNormal ROM45 degreesGluteus mediusAdductionNormal ROM30 degreesAdductor magnus, longus, brevis, and gracilis

  • Muscles and Movements (3)Internal Rotation or Medial RotationNormal ROM45 degreesGlueteus Minimus and Tensor Fascia LataeExternal Rotation or Lateral RotationNormal ROM45 degrees6 deep external rotators- piriformis

  • Quadriceps ContusionsMOI: direct blowHOPSPain, swelling and ecchymosisWalk with a limpPalpable hematoma, with heatTxIce in stretched position, crutches if needed, wrap, See field strategy 10.2 (pg. 352), refer for x-ray

  • Myositis OssificansAccumulation of mineral deposits (bone) in muscle tissueMOI: Single severe blow, repeated blows to muscle, mismanagement of contusionHOPSFirm swollen area in musclePalpable massLimited knee flexionActive contraction of muscle difficultTxRefer to physician (surgery may be needed)

  • Hip PointerContusion caused by direct compression to the iliac crestMOI: Direct blowHopsPn with rotation, trunk flexionEcchymosis, pain, swelling,Point tender over illiac crestTXRICE, refer for x-ray, donut pad and hard outer shell, to protect

  • BursitisMost common = trochanteric bursitisMOI: overuseHOPS:Deep achy pain in lateral thighPn with resisted abductionTXHeat, stretch abductors, UltrasoundIf condition does not resolve: refer to physician

  • Hip Sprains/ DislocationsMOI: violent twisting/ severe trauma; rare in sportsHOPS: S/S with degree and typeIntense pain,Inability to walk or move hipHip flexed and internally rotated Fig 10-12TXSymptomatic with mild to moderate sprainsMedical emergency, summon EMS, check distal neurovascular status; treat for shock

  • Muscle StrainsHamstring strains more probable than Quadriceps strains; Adductor strains are more common than AbductorHamstring Strains are most commonPrecursorsmuscle imbalances, tight muscles, improper warm-up, overuse, fatigue, dynamic overload

  • Muscle Strains (2) HOPS-In isolated region in questiontwinge or pullWeakness on RROM testingLimping; EcchymosisPop is heard when severe; Palpable defectPain with passive stretch, and resistive motionTreatment- Hip Flexor or Hip Adductor Wrap; RICE, E-Stim, Strengthening/Stretching, NSAIDs; crutches if necessary

  • Muscle Strength Testing5 (normal) full strength against resistance4 (good) partial strength against resistance3 (fair) ability to move the body part no resistance2 (poor) able to contract muscle1 (trace) no evidence of contractility

  • Legg-Calve-Perthes DiseaseAvascular necrosis (decreased blood supply to the head of femur) of the proximal femoral epiphysis-Fig 10-13Precursors: young males 3-8 years oldHOPS:Gradual onset of pain in hip/groin or knee with no explanationGradual onset of a limp; Decreased range of motion in the hip- AB, EX, ERTX: refer to physician if unexplained hip, thigh or knee pain last for more than a week.

  • Avulsion Fractures (1)Precursors:Individuals who perform rapid acceleration/ decelerationLocations:ASIS: SartoriusAIIS: Rectus FemorisIschial tuberosity: hamstrings

  • Avulsion Fractures (2)HOPSSudden acute localized painPain, swelling, discoloration over areaPain with resisted stretching of the involved muscleTXHip Spica Wrap if ableFit for crutchesRefer to physician

  • Slipped Femoral EpiphysisEpiphyseal/ Growth Plate fracture- Fig 10-15Precursor: Adolescent boys ages 8 15, obese or slender rapidly growing boysHOPS:Painful limpPain in the groin, anterior thigh or kneeUnable to internally rotate femurUnable to stand on injured legTX: Refer to physician, surgery

  • Stress FracturesPrecursor: Box 10-3Common locationsPubisFemoral neckProximal 1/3 of femurHOPSAching pain in groin or thigh during WBPn relieved by restNight painTX: Refer to physician

  • RROM testingHip FlexionHip ExtensionHip AbductionHip AdductionHip Internal RotationHip External RotationKnee ExtensionKnee flexion

  • Measuring for Leg LengthASISMedial MalleolusPatient Position:Lying on table, pelvis square and balancedLegs parallelHeels approximately 6-8 inches apart

  • Special TestsThomas Test = Hip flexion contracturesKendall Test = Hip flexion contractures (Rectus Femoris)Straight Leg Raise=Disc Lesions or tight hamstringsPelvic Rock Test=Pelvic Fracture/SI Joint SprainTrendelenburgs Test

  • Specialized RehabSLRs- all 4 planesQuad Sets/Glute Sets/Ham SetsStretchingStrengtheningElectrical Stimulation, US, Massage