Transcript
Page 1: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to Pelvis and Hip

Page 2: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Anatomy of PelvisAnatomy of Pelvis

• Bones of pelvic girdle1. ilium2. ischium3. pubis4. sacrum** ilium, ischium, and

pubis combined form the 2 pelvic bones

• Articulations of pelvic girdle1. sacroiliac joint2. pubis symphysis

Page 4: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Major Muscles of Pelvis

1. Hip Flexion• Iliopsoas

– Iliacus– Psoas Major

• sartorius• quadricep muscles

2. Abduction • gluteus medius• gluteus minimus• tensor fasciae latae

3. Adduction• adductor longus• adductor magnus • adductor brevis• gracilis• pectineus

4. Hip Extension• hamstrings• gluteus maximus

Page 6: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Identification

• Identify the following:– Illium– Ischium– Pubis– Sacrum– Sacroiliac joint– Pubis symphasis– Iliac crest

Page 7: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Identification

• Identify the following:– Psoas Major– Iliacus– Tensor Fasciae Latae– Adductor Magnus– Adductor Brevis– Adductor Longus – Gracilias– Pectineus– Piriformis

Page 8: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Identification

• Identify the following:– Gluteus Maximus– Gluteus Minimus– Gluteus Medius

Page 9: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Blood Supply to Lower Extremities

• Arteries– Iliac – femoral – popliteal– tibial– peroneal

• Veins– iliac– femoral– saphenous– popliteal– tibial– peroneal

Page 10: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 11: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Blood Supply to Pelvis

• Pelvic Blood Supply– Iliac artery

• Internal• External

Page 12: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to Pelvic Region

• Fractures in Pelvic Region• Very rare in sports• Most common

1. stress

2. avulsion

• Symptoms1. altered gait

2. localized pain

Page 13: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Stress Fractures

• Stress Fx– Small crack in bone– Overuse injury– Uncommon in pelvic

area (1 to 7% of reported stress fx)

– Seen mainly in distance runners

– More common in females

Page 14: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Stress Fractures

• Stress Fx– Symptoms

• Chronic pain in pelvis area

• Gets worse with activity

– Diagnosis• X-rays and bone scans

– Treatment• Rest / no activity• Some may need

crutches for few days

Page 15: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Stress Fracture

Page 16: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Avulsion Fracture

• Avulsion Fx– Piece of bone pulls away at

tendon attachment site

– Caused when muscle contracts too rapidly or quickly (sudden stops, starts or jumping)

– Symptoms• May hear or feel a “pop”

• Immediate pain• Decreased ROM• Limping

Page 17: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Avulsion Fractures

• Avulsion Fracture– Treatment

• 4 to 6 weeks of rest• Physical Therapy

– Incidences• Rare but seen in sports

that require sprinting or rapid changes in movement

• Basketball, track and soccer

Page 18: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Avulsion Fractures

• Can occur at many points along pelvis– Iliac crest

– Anterior superior iliac spine (ASIS)

– Anterior inferior iliac spine (AIIS)

– Ischial tuberosity

– Pubic symphysis

Page 19: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Common Avulsion Fracture Sites

Page 20: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

• Avulsion fx of left ischium

• Avulsion fx of anterior superior iliac spine

Page 21: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Avulsion Fracture

Page 22: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Hip Pointers

• Hip Pointers– Blow to the iliac crest– Causes bone bruise– Symptoms

• Point tenderness along iliac crest/spine

• Loss of ROM

– Treatment• Rest• Ice• ROM exercises• Donut shaped padding

Page 23: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Hip Pointers

Page 24: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Hip Pointers

Page 25: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to Pelvic Region

• Strains (Adductors or Hip Flexors)– Mechanism of Injury

1. extreme rotation

2. excessive abduction– Treatment

1. ice

2. stretch

3. leg strengthening

Page 26: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Anatomy of Hip and ThighAnatomy of Hip and Thigh

• Bones1. Femur2. Pelvic bone

• Articulations (Hip Joint)1. Head of femur2. Acetabulum of pelvis

bone** ball and socket joint

Page 27: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Bony Landmarks of Hip

• Hip Joint– Acetabulum

• “socket” for hip joint

– Femoral Head• “ball” for hip joint

– Greater trochanter– Lesser trochanter– Femoral neck– Femur

Page 28: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 29: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

ROMS of Hip Joint

• Flexion

• Extension

• Abduction

• Adduction

• Medial Rotation

• Lateral Rotation

Page 30: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Major Muscles of HipMajor Muscles of Hip

• Hip flexion & Knee extension– Anterior thigh muscles

• Quadriceps Group –rectus femoris, –vastus medialus, –vastus lateralis, –vastus intermedius

Page 31: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 32: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Major Muscles of HipMajor Muscles of Hip

• Hip extension & Knee flexion– Posterior thigh muscles

• Hamstring Group – –Semitendinosus–Semimembranosus–Biceps femoris

Page 33: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 34: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 35: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to the Hip and ThighInjuries to the Hip and Thigh

• Fractures of Femur– Great force required to break femur– Contact sports, BMX, skateboarding,

motorcross increase risk– Splint, send to physician, or call EMS

Page 36: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Femur Fracture

Page 37: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 38: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 39: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Femoral Neck Fracture Repair

Page 40: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 41: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to the Hip and ThighInjuries to the Hip and Thigh

• Subluxation / Dislocation– Symptoms

1. complete loss of function2. severe pain3. deformity

– Mechanism of Injury1. direct blow2. twisting force

Page 42: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Dislocated Hip

Page 43: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 44: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Subluxation of the hip

Page 45: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to the Hip and ThighInjuries to the Hip and Thigh• Contusions

– “Charley Horse” = bruise to the quad muscles

– Mechanism of Injury• Direct blow to thigh causing bleeding in the muscle

tissue

– Treatment1. ICE2. keep knee flexed while applying ice3. mild stretching through pain free ROM** if stretching is not done, blood will pool and leave

area vulnerable to myositis ossificans

Page 47: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 48: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to the Hip and ThighInjuries to the Hip and Thigh

• Sprains– Mechanism of injury

1. sudden jerking or twisting motions2. more frequent in non or poor conditioned athletes

– Treatment• PRICE• Stretching & ROM exercises• If injury doesn’t improve within 3 days, send to

physician

Page 49: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to the Hip and ThighInjuries to the Hip and Thigh

• Strains– Most common = hamstrings, hip flexor,

adductors and quad

– Treatment• ICE• Stretching• Strengthening

Page 50: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Injuries to the Hip and ThighInjuries to the Hip and Thigh• Bursitis / Synovitis

– Most common is inflammation of the trochanter bursa

– Mechanism of Injury1. direct blow2. repeated stress

– Symptoms1. slight swelling2. persistent ache

– Treatment1. rest2. stretching

Page 51: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form
Page 52: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Special Tests for Hip and PelvisSpecial Tests for Hip and Pelvis

• Thomas Test – hip flexor flexibility

Negative

Positive

Page 53: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Special Tests for Hip and PelvisSpecial Tests for Hip and Pelvis

• Ober’s Test – Iliotibial (IT) band flexibility

Page 54: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Iliotibial (IT) Band

Page 55: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Stretches for IT Band

Page 56: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Special Tests for Hip and PelvisSpecial Tests for Hip and Pelvis

• Patrick’s or Faber Test – deformity or weakness of the iliopsoas muscle and sacroiliac pain

Page 57: Injuries to Pelvis and Hip. Anatomy of Pelvis Bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4. sacrum ** ilium, ischium, and pubis combined form

Special Tests for Hip and PelvisSpecial Tests for Hip and Pelvis• Trendelenburg Test – hip abductor

weakness


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