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 Head of the femur- Convex Acetabulum of the pelvis- Concave Highly Stable from a bony perspective; several very

strong ligaments that aid in keeping the head of femur in the acetabulum

Bursae– Iliopsoas bursa– Deep trochanteric bursa

Nerves and Blood Supply

Nerve supply– Lumbar plexus (L1 – L4) - forms the femoral nerve– Sacral Plexus (L4 – S4) – forms the sciatic nerve

Blood supply– Femoral artery

Muscles and Movements

Hip flexion – Normal ROM

80 degrees knee straight 120 degrees knee bent bent

– Iliacus and psoas major (major flexors)- both form the illiopsoas- knee bent

– Rectus femoris (function when knee is extended and with kicking the ball)

– Sartorius Hip Extension

– Normal ROM 10 – 20 degrees– Hamstrings, gluteus maximus

Muscles and Movements (2)

Abduction– Normal ROM

45 degrees– Gluteus medius

Adduction– Normal ROM

30 degrees– Adductor magnus, longus, brevis, and gracilis

Muscles and Movements (3)

Internal Rotation or Medial Rotation– Normal ROM

45 degrees– Glueteus Minimus and Tensor Fascia Latae

External Rotation or Lateral Rotation– Normal ROM

45 degrees– 6 deep external rotators- piriformis

Quadriceps Contusions

MOI: direct blow HOPS

– Pain, swelling and ecchymosis– Walk with a limp– Palpable hematoma, with heat

Tx– Ice in stretched position, crutches if needed, wrap,

See field strategy 10.2 (pg. 352), refer for x-ray

Myositis Ossificans

Accumulation of mineral deposits (bone) in muscle tissue MOI: Single severe blow, repeated blows to muscle,

mismanagement of contusion HOPS

– Firm swollen area in muscle– Palpable mass– Limited knee flexion– Active contraction of muscle difficult

Tx– Refer to physician (surgery may be needed)

Hip Pointer

Contusion caused by direct compression to the iliac crest

MOI: Direct blow Hops

– Pn with rotation, trunk flexion– Ecchymosis, pain, swelling,– Point tender over illiac crest

TX– RICE, refer for x-ray, donut pad and hard outer shell, to protect

Bursitis

Most common = trochanteric bursitis MOI: overuse HOPS:

– Deep achy pain in lateral thigh– Pn with resisted abduction

TX– Heat, stretch abductors, Ultrasound– If condition does not resolve: refer to physician

Hip Sprains/ Dislocations

MOI: violent twisting/ severe trauma; rare in sports HOPS: S/S with degree and type

– Intense pain,– Inability to walk or move hip– Hip flexed and internally rotated – Fig 10-12

TX– Symptomatic with mild to moderate sprains– Medical emergency, summon EMS, check distal

neurovascular status; treat for shock

Muscle Strains

Hamstring strains more probable than Quadriceps strains; Adductor strains are more common than Abductor

Hamstring Strains are most common Precursors

– muscle imbalances, tight muscles, improper warm-up, overuse, fatigue, dynamic overload

Muscle Strains (2)

HOPS-In isolated region in question– “twinge” or “pull”– Weakness on RROM testing– Limping; Ecchymosis– Pop is heard when severe; Palpable defect– Pain with passive stretch, and resistive motion– Treatment- Hip Flexor or Hip Adductor Wrap; RICE,

E-Stim, Strengthening/Stretching, NSAID’s; crutches if necessary

Muscle Strength Testing

5 (normal) full strength against resistance 4 (good) partial strength against resistance 3 (fair) ability to move the body part no

resistance 2 (poor) able to contract muscle 1 (trace) no evidence of contractility

Legg-Calve-Perthes Disease

Avascular necrosis (decreased blood supply to the head of femur) of the proximal femoral epiphysis-Fig 10-13

Precursors: young males 3-8 years old HOPS:

– Gradual onset of pain in hip/groin or knee with no explanation– Gradual onset of a limp; – Decreased range of motion in the hip- AB, EX, ER

TX: 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/

deceleration Locations:

– ASIS: Sartorius– AIIS: Rectus Femoris– Ischial tuberosity: hamstrings

Avulsion Fractures (2)

HOPS– Sudden acute localized pain– Pain, swelling, discoloration over area– Pain with resisted stretching of the involved muscle

TX– Hip Spica Wrap if able– Fit for crutches– Refer to physician

Slipped Femoral Epiphysis

Epiphyseal/ Growth Plate fracture- Fig 10-15 Precursor: Adolescent boys ages 8 – 15, obese or

slender rapidly growing boys HOPS:

– Painful limp– Pain in the groin, anterior thigh or knee– Unable to internally rotate femur– Unable to stand on injured leg

TX: Refer to physician, surgery

Stress Fractures

Precursor: Box 10-3 Common locations

– Pubis– Femoral neck– Proximal 1/3 of femur

HOPS– Aching pain in groin or thigh during WB– Pn relieved by rest– Night pain

TX: Refer to physician

RROM testing

Hip Flexion Hip Extension Hip Abduction Hip Adduction Hip Internal Rotation Hip External Rotation Knee Extension Knee flexion

Measuring for Leg Length

ASIS Medial Malleolus Patient Position:

– Lying on table, pelvis square and balanced– Legs parallel– Heels approximately 6-8 inches apart

Special Tests

Thomas Test = Hip flexion contractures Kendall Test = Hip flexion contractures (Rectus

Femoris) Straight Leg Raise=Disc Lesions or tight

hamstrings Pelvic Rock Test=Pelvic Fracture/SI Joint

Sprain Trendelenburg’s Test

Specialized Rehab

SLR’s- all 4 planes Quad Sets/Glute Sets/Ham Sets Stretching Strengthening Electrical Stimulation, US, Massage