Unit 21: The Thigh, Hip, Groin, and Pelvis. Anatomy of the Pelvis, Thigh, and Hip

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

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  • Unit 21: The Thigh, Hip, Groin, and Pelvis
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  • Anatomy of the Pelvis, Thigh, and Hip
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  • Bony Anatomy Pelvic Girdle Ilium Iliac crest Anterior superior iliac spine Posterior superior iliac spine Anterior inferior iliac spine
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  • Ischium Ischial tuberosity Hamstring or bursa problems Should sit on this area of pelvis Pubis Pubic symphysis Acetabulum
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  • Femur Head Neck Greater trochanter Lesser trochanter Shaft Medial condyle Lateral condyle
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  • Ligaments - Major source of strength Ligamentum teres-head of femur Iliofemoral ligament Y ligament Strongest in the body Prevents hyperextension, external rotation, abduction
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  • Pubofemoral ligament Prevents abduction Ischiofemoral ligament Prevents medial rotation
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  • Bursa 18 in hip Ischial bursa Greater trochanteric bursa Found at attachment of gluteus maximus and IT band Iliopsoas
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  • Muscles Flexors Iliopsoas Rectus femoris (quad) Sartorius Anterior thigh (quads) Vastus medialis Vastus lateralis Vastus intermedialis
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  • Extensors Gluteus maximus Semitendonosis (hamstring) Semimembranosis (hamstring) Biceps femoris (hamstring) Abductors Gluteus medius Gluteus minimus Tensor fascia latae (Iliotibial band)
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  • Adductors Adductor magnus Adductor brevis Adductor longus Pectineus Gracilis
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  • External Rotators Oburator externus Obturator internus Quadratus femoris Piriformis sciatic nerve goes through it. Gamellus superior Gamellus inferior Gluteus maximus
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  • Internal Rotators Gluteus minimus Tensor fascia Latae Gluteus medius
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  • Assessment of the Thigh History Onset (sudden or slow?) Previous history? Mechanism of injury? Pain description, intensity, quality, duration, type and location?
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  • Observation Postural symmetry? Size, deformity, swelling, discoloration? Skin color and texture? Is athlete in obvious pain? Is the athlete willing to move the thigh?
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  • 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
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  • 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
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  • Trendelenburg Test Gluteus medius Obers/Noble Test IT Band Fulcrum
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  • 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
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  • 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
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  • Quad Contusion
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  • Care RICE and NSAIDs 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
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  • 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
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  • 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)
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  • 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
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  • Care RICE to control internal bleeding Determine extent of injury early Neoprene sleeve may provide some added support
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  • 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
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  • 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 Grade 2 increase pain, swelling, palpable swelling/defect? Grade 3 - Rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap
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  • Care RICE Restrict activity until soreness has subsided Ballistic stretching and explosive sprinting should be avoided initially
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  • 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
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  • Care Treat for shock, verify neurovascular status, splint before moving, reduce following X-ray Secure immediate emergency assistance and medical referral
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  • 8 foot fall
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  • 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, NSAIDs RICE ROM and PRE exercises are carried out w/ pain free ROM Rest, limited weight bearing
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  • 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
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  • Signs of Injury Sudden twinge or tearing during active movement Produce pain, weakness, and internal hemorrhaging Care RICE, NSAIDs and analgesics for 48-72 hours Determine exact muscle or muscles involved Rest is critical Restore normal ROM and strength -- provide support w/ wrap Refer to physician if severe groin pain is experienced
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  • Sprains of the Hip Joint Cause of Injury Result of violent twist due to forceful contact Force from opponent/object or trunk forced over planted foot in opposite direction Signs of Injury Signs of acute injury and inability to circumduct hip Pain in hip region, w/ hip rotation increasing pain
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  • Care X-rays or MRI should be performed to rule out fx RICE, NSAIDs and analgesics Depending on severity, crutches may be required ROM and PRE are delayed until hip is pain-free
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  • Dislocated Hip Cause of Injury Rarely occurs in sport Result of traumatic force directed along the long axis of the femur Signs of Injury Flexed, adducted and internally rotated hip Palpation reveals displaced femoral head, posteriorly Serious pathology Soft tissue, neurological damage and possible fx
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  • Care Immediate medical care (blood and nerve supply may be compromised) Contractures may further complicate reduction 2 weeks immobilization and crutch use for at least one month
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  • 7 y/o posterior hip dislocation skate board fall
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  • Posterior Hip Dislocation injury footage
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  • Anterior Hip Dislocation Notice leg position
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  • Hip Problems in the Young Athlete Legg-Perthes Disease (Coxa Plana) Cause of Condition Avascular necrosis of femoral head: children 4-10 y/o Articular cartilage becomes necrotic, flattens Signs of Condition Pain in groin, can refer to abdomen or knee Limping is also typical Varying onsets and may exhibit limited ROM