KIN 188 – Prevention and Care of Athletic Injuries

Hip and Thigh Evaluation and Injuries

Anatomy

Bony Anatomy Hip vs. pelvis Acetabulum

“Socket” of ball and socket joint

Reinforced by labrum Ligaments primarily

thickenings of joint capsule

Femur Head and neck Greater/lesser

trochanters

Muscular Anatomy Anterior

Quadriceps, sartorius, iliopsoas

Posterior Gluteus maximus, hamstrings

Medial Gracilis, adductor longus/brevis/magnus

Lateral Tensor fascia latae (TFL) with IT band, gluteus

medius/minimus, deep external rotators (6)

Evaluation

History

Mechanism of injury/etiology Direct trauma (contusion, fracture, bursitis) Hyperextension (hip flexor strain, capsular

sprain) Internal rotation/adduction (posterior dislocation) External rotation/abduction (anterior dislocation) “Cutting” move (groin/hip flexor strain) Overuse (tendonitis, bursitits)

History

Unusual sounds/sensations “Snapping/popping” (tendonitis, bursitis) “Pulling” (muscle strain)

History of previous injury/surgery

History Change in activity

Intensity, duration, frequency, surface change, footwear change

Acute/gradual onset of symptoms Macrotraumatic vs. microtruamatic

Characterize pain Location (point with 1 finger) Dull, sharp, burning, throbbing, etc. Rate on scale (1-10) What increases or decreases?

Treatment, medication, evaluation to date

Inspection/Observation ALWAYS compare bilaterally Obvious deformity

Scoliosis/lordosis/kyphosis Hip height Pes planus/cavus Genu valgum/varum/recurvatum

Bleeding Discoloration/ecchymosis Swelling Scars Gait/posturing

Palpation

Anterior superior iliac spine (ASIS)

Posterior superior iliac spine (PSIS)

Iliac crests Ischial tuberosity

Pubic symphysis Greater trochanter Anterior/

posterior/medial/lateral musculature

Special Tests ROM

Active – patient/athlete moves joint Passive – clinician moves joint, evaluates end

feel Resistive – proximal stabilization and distal

application of resistance (“break” test vs. resistance through ROM)

Neurovascular

Special tests

ROM

Hip flexion Iliopsoas, sartorius (figure

4), rectus femoris (quad, 2 jt muscle)

Hip extension Gluteus maximus,

hamstrings (2 jt muscles) Hip adduction

Adductor longus/brevis/magnus, gracilis

Hip abduction TFL, gluteus

medius/minimus Hip internal rotation

Gluteus medius/minimus

Hip external rotation Gluteus maximus,

deep external rotators (6)

Neurovascular Neurological evalation

Nerve root level and peripheral nerve sensory and motor distributions

Vascular evaluation Skin temperature/color Capillary refill Femoral pulse Popliteal pulse Dorsal pedal pulse Posterior tibial pulse

Special Tests

Since no easily identified specific ligamentous structures, stress tests done via passive ROM end feel evaluation

Thomas test – tight hip flexors

Ober test – tight IT band

Injuries

Bony Injuries

Femur fracture Involves significant

trauma – not common in athletics

Bony Injuries

Stress fracture Femoral shaft and

neck most common Difficult to

differentiate from muscular injury

Joint Injuries

Hip dislocation Posterior more

common than anterior

Neurovascular considerations

Muscular Injuries Typically associated with dynamic overload to

eccentric contractions (moving and lengthening – cutting)

Pain usually felt at musculotendinous junction and/or at insertion site (tendon to bone)

Most involved include quadriceps, hamstrings, hip flexors, adductors

Additional Injuries Quadriceps contusion

Substantial bleeding and hematoma formation

Risk of myositis ossificans

Bursitis Most common is

trochanteric at greater trochanter – “snapping hip syndrome”