Kin191 A.Ch.8. Pelvis. Thigh. Injuries

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Text of Kin191 A.Ch.8. Pelvis. Thigh. Injuries

  • 1. KIN 191A Advanced Assessment of Lower Extremity Injuries THE PELVIS AND THIGH INJURIES

2. INTRODUCTION

  • MUSCLE STRAINS
  • BURSITIS
  • DEGENRATIVE HIP CHA N GES
  • PIRIFORMIS SYNDROME
  • ILLIAC CREST CONTUSION
  • QUADRICEPS CONTUSION
  • HIP DISLOCATION
  • FEMUR FRACTURES/STRESS FRACTURES

3.

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

4. MUSCLE STRAINS

  • Typically associated with dynamic overload toeccentric contractions
  • Pain usually felt at musculotendinous junction and/or at insertion site
  • Most involved include quadriceps, hamstrings, hip flexors, adductors

5. 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

6. DEGENERATIVE HIP CHANGES

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

7. 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

8. ILIAC CREST CONTUSION

  • Commonly referred to as hip pointer
  • Attachment site for abdominal, lumbar and pelvic/hip musculature

9. 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

10. 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

11. FEMUR FRACTURES

  • Involve significant trauma atypical in athletics
  • Present with immediate loss of function, pain and deformity

12. 13. 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

14. 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

15. 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

16. AVULSION FRACTURES

  • ASIS Sartorius
  • AIIS Rectus femoris
  • Pubis Adductors
  • Ischial tuberosity Hamstrings