Thigh & Hip

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  • 1. Chapter 21: The Thigh, Hip, Groin, and Pelvis

2. Activity- Anatomy Review Lower Extremity 3. Assessment of the Thigh, Hip and Pelvis History Onset (sudden or slow?) Previous history? Mechanism of injury? Pain description, intensity, quality, duration, type and location? Observation Symmetry? Size, deformity, swelling, discoloration? Skin color and texture? Is athlete in obvious pain? Is the athlete willing to move the thigh? 4. Observation Symmetry- hips, pelvis tilt (anterior/posterior) Lordosis or flat back Lower limb alignment Knees, patella, feet Pelvic landmarks (ASIS, PSIS, iliac crest) Standing on one leg Pubic symphysis pain or drop on one side Ambulation Walking, sitting - pain will result in movement distortion 5. Leg Length Discrepancy Measures 6. Contusions Quadriceps Contusions Etiology Blunt Trauma Signs and Symptoms Pain transitory loss of function Immediate swelling and deformity Grades 1-3 7. Myositis Ossificans Myositis Ossificans Traumatica Etiology Inflammation of the muscle leading to bone formation Signs and Symptoms X-ray shows calcium deposit 2-6 weeks following injury Pain, weakness, swelling, tissue tension and point tenderness w/ decreased ROM 8. Contusions (contd) Hip Pointer Etiology Direct blow to iliac crest or abdominal musculature Signs and Symptoms Pain, spasm, and transitory paralysis of soft structures Pain is extreme Obvious swelling and bruising Decreased trunk and hip ROM 9. Myositis Ossificans is: 1. An inflammation of bone 2. An inflammation resulting in bone formation 3. An inflammation resulting in ecchymosis 4. None of the above25%25%25%25%1234 10. Strains Quadriceps Muscle Strain Etiology Sudden stretch when athlete falls on bent knee or experiences sudden contraction Associated with weakened or over constricted muscle Signs and Symptoms Peripheral tear causes fewer symptoms than deeper tear Pain, point tenderness, spasm, loss of function and little discoloration Grades 1-3 11. Strains (contd) Groin Strain Etiology One of the more difficult problems to diagnose Injury to one of the muscles in the regions (generally adductor longus) Occurs from running , jumping, twisting w/ hip external rotation or severe stretch Signs and Symptoms Pain with forced hip adduction, adduction, rotation, extension Decreased ROM May be a deformity, swelling, bruising Grades 1-3 12. Strains (contd) Hamstring Muscle Strains Etiology Multiple theories of injury Most commonly due to a forceful eccentric contraction Signs and Symptoms Pain, decreased ROM, decreased strength, point tenderness, deformity, bruising Grades 1-3 13. A 3rd degree hamstring strain will result in: 1. 2. 3. 4. 5.Mild pain Moderate swelling Loss of function All of the above None of the above20%20%20%20% 20%12345 14. A 2nd degree quadriceps contusion will result in: 1. 2. 3. 4. 5.Mild pain Moderate swelling Loss of function All of the above None of the above20%20%20%20% 20%12345 15. Fractures Femoral Fractures Etiology Generally involving shaft and requiring a great deal of force Occurs in middle third due to structure and point of contact Signs and Symptoms Pain, swelling, deformity Muscle guarding, hip is adducted and ER Leg with fx may also be shorter Potential serious neurovascular complications 16. Overuse injuries (contd) Trochanteric Bursitis (Snapping Hip) Etiology Inflammation at the site where the gluteus medius inserts or the ITband passes over the trochanter Signs and Symptoms Complaint of lateral hip pain that may radiate down the leg Palpation reveals tenderness over lateral aspect of greater trochanter May hear an audible snap 17. Osteitis Pubis Etiology Seen in distance runners Repetitive stress on pubic symphysis and adjacent muscles Acute case may be the result of bicycle seat 18. Dislocations Dislocated Hip Etiology Rarely occurs in sport Result of traumatic force directed along the long axis of the femur (posterior dislocation w/ hip flexed and adducted and knee flexed) Signs and Symptoms Flexed, adducted and internally rotated hip Palpation reveals displaced femoral head posteriorly Serious pathology Soft tissue, neurological damage and possible fx 19. Hip dislocations rarely occur in sports. 1. True 2. False50%150%2 20. Hip Problems in the Young Athlete Legg Calve-Perthes Disease (Coxa Plana) Etiology Avascular necrosis of the femoral head in child ages 4-10 Slipped Capital Femoral Epiphysis Etiology Found mostly in boys ages 10-17 who are characteristically tall and thin or obese May be growth hormone related 25% of cases are seen in both hips, trauma accounts for 25% Head slippage on X-ray appears posterior and inferior 21. Avulsion Fractures and Apophysitis Etiology Traction epiphysis (bone outgrowth) Common sites include ischial tuberosity, AIIS, and ASIS Avulsions seen in sports w/ sudden accelerations and decelerations May occur insidiously Signs and Symptoms Sudden localized pain w/ limited movement Pain, swelling, point tenderness Muscle testing increases pain