KIN 191AAdvanced Assessment of Lower

Extremity Injuries

THE PELVIS AND THIGHINJURIES

INTRODUCTION• MUSCLE STRAINS• BURSITIS• DEGENRATIVE HIP CHANGES• PIRIFORMIS SYNDROME• ILLIAC CREST CONTUSION• QUADRICEPS CONTUSION• HIP DISLOCATION• FEMUR FRACTURES/STRESS FRACTURES

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• SI JOINT DYSFUNCTION• OSTEITIS PUBIS• AVULSION FRACTURES (ASIS, AIIS, pubis, ischial tuberosity)

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MUSCLE STRAINS

• Typically associated with dynamic overload to eccentric contractions

• Pain usually felt at musculotendinous junction and/or at insertion site

• Most involved include quadriceps, hamstrings, hip flexors, adductors

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BURSITIS• Trochanteric– Either from direct trauma or repetitive friction

from IT band during knee flexion/extension– Often referred to as “snapping hip syndrome”

• Ischial– Either from direct trauma or movement in sitting

position (rowing, biking, etc.)• Iliopsoas– Anterior hip pain, difficult to differentiate from hip

flexor strain

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DEGENERATIVE HIP CHANGES

• Develop secondary to repetitive trauma, age, acute injury– Arthritis– OCD– Avascular necrosis

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PIRIFORMIS SYNDROME• “Sciatic” nerve proximity to

piriformis muscle• Spasm or hypertrophy of muscle

can produce “sciatica” – referred pain to buttocks or posterior leg

• May have pain with hip flexion motions

• Must evaluate sensory and motor function of involved structures

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ILIAC CREST CONTUSION

• Commonly referred to as “hip pointer”

• Attachment site for abdominal, lumbar and pelvic/hip musculature

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QUADRICEPS CONTUSION

• Significant bleeding leads to hematoma formation

• Typically presents with significant loss of ROM to knee flexion

• Risk of myositis ossificans• Must treat appropriately

acutely

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HIP DISLOCATION• Posterior more common

than anterior• Often associated with

femoral neck and/or acetabular fractures

• Classic presentation is adduction and internal rotation

• Neurovascular considerations

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FEMUR FRACTURES

• Involve significant trauma – atypical in athletics

• Present with immediate loss of function, pain and deformity

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STRESS FRACTURES

• Femoral shaft and neck are most common sites

• Difficult to differentiate from soft tissue injury (strain or tendonitis)

• Differential diagnosis made via bone scan

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SI JOINT DYSFUNCTION

• Collective term for multiple non-specific pathologies

• If accentuated motions occur at SI joint due to trauma or repetitive stress typically presents with rotation of ilium on sacrum

• May present as abnormal position due to muscle tightness/weakness or imbalances

• Must conduct comprehensive neurological evaluation since symptoms often replicate nerve root injury

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OSTEITIS PUBIS

• Chronic inflammatory condition at symphysis pubis from repetitive stress to area primarily from running

• May present with groin pain, pubic symphysis pain and discomfort with abdominal/hip adduction exercises due to muscular attachments

• Difficult to treat – may need injection

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AVULSION FRACTURES

• ASIS – Sartorius

• AIIS – Rectus femoris

• Pubis – Adductors

• Ischial tuberosity – Hamstrings

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