Unit 21: The Thigh, Hip, Groin, and Pelvis

1. Unit 21: The Thigh, Hip, Groin, and Pelvis

2. Anatomy of the Pelvis, Thigh, and Hip

5. Bony Anatomy • Pelvic Girdle • Ilium • Iliac crest • Anterior superior iliac spine • Posterior superior iliac spine • Anterior inferior iliac spine

6. Ischium • Ischial tuberosity • Hamstring or bursa problems • Should sit on this area of pelvis • Pubis • Pubic symphysis • Acetabulum

8. Femur • Head • Neck • Greater trochanter • Lesser trochanter • Shaft • Medial condyle • Lateral condyle

10. Ligaments - Major source of strength • Ligamentum teres-head of femur • Iliofemoral ligament • Y ligament • Strongest in the body • Prevents hyperextension, external rotation, abduction

11. Pubofemoral ligament • Prevents abduction • Ischiofemoral ligament • Prevents medial rotation

12. Bursa • 18 in hip • Ischial bursa • Greater trochanteric bursa • Found at attachment of gluteus maximus and IT band • Iliopsoas

14. Muscles • Flexors • Iliopsoas • Rectus femoris (quad) • Sartorius • Anterior thigh (quads) • Vastus medialis • Vastus lateralis • Vastus intermedialis

15. Extensors • Gluteus maximus • Semitendonosis (hamstring) • Semimembranosis (hamstring) • Biceps femoris (hamstring) • Abductors • Gluteus medius • Gluteus minimus • Tensor fascia latae (Iliotibial band)

16. Adductors • Adductor magnus • Adductor brevis • Adductor longus • Pectineus • Gracilis

18. External Rotators • Oburator externus • Obturator internus • Quadratus femoris • Piriformis – sciatic nerve goes through it. • Gamellus superior • Gamellus inferior • Gluteus maximus

19. Internal Rotators • Gluteus minimus • Tensor fascia Latae • Gluteus medius

20. Assessment of the Thigh • History • Onset (sudden or slow?) • Previous history? • Mechanism of injury? • Pain description, intensity, quality, duration, type and location?

21. Observation • Postural symmetry? • Size, deformity, swelling, discoloration? • Skin color and texture? • Is athlete in obvious pain? • Is the athlete willing to move the thigh?

22. Palpation • Soft tissue of the thigh (anterior, posterior, medial, lateral) should be palpated for pain and tenderness • Bony palpation should also be performed to locate areas of pain/discomfort • Utilize palpation to assess body symmetry

23. Special Tests • Thomas test • Test for hip contractures • Straight Leg Raise • Test for hip extensor tightness • Can also be used to assess low back or SI joint dysfunction Thomas Test

24. Trendelenburg Test • Gluteus medius • Ober’s/Noble Test • IT Band • Fulcrum

25. Prevention of Thigh Injuries • Thigh must have maximum strength, endurance, and extensibility to withstand strain • Dynamic stretching programs may aid in muscle preparation for activity • Strengthen programs can also help in preventing injuries

26. Thigh Injuries • Quadriceps Contusions • Cause of Injury • Constantly exposed to traumatic blows • Signs of Injury • Pain, transitory loss of function, immediate bleeding of affected muscles • Early detection and avoidance of internal bleeding are vital – increases recovery rate and prevents muscle scarring

27. Quad Contusion

28. Care • RICE and NSAID’s • Crutches for more severe cases • Isometric quadriceps contractions should begin as soon as tolerated • Heat, massage and ultrasound to prevent myositisossificans • Padding may be worn for additional protection upon return to play

29. Myositis Ossificans Traumatica • Cause of Injury • Formation of ectopic bone following repeated blunt trauma • Signs of Injury • X-ray shows calcium deposit 2-6 weeks following injury • Pain, weakness, swelling, decreased ROM • Tissue tension and point tenderness • If condition is recurrent it may indicate problem with blood clotting

30. Care • Treatment must be conservative • May require surgical removal if too painful and restricts motion (after one year - remove too early and it may come back)

32. Quadriceps Muscle Strain • Cause of Injury • Sudden stretch-falls on bent knee or experiences sudden contraction • Weakness or over constricted muscle • Signs of Injury • Peripheral tear causes fewer sx than deeper tear • Pain, pt tenderness, spasm, loss of function and little discoloration • Complete tear may leave athlete w/ little disability/discomfort but with some deformity

33. Care • RICE to control internal bleeding • Determine extent of injury early • Neoprene sleeve may provide some added support

35. Hamstring Muscle Strains • Cause of Injury • Multiple theories of injury • Hamstring and quad contract together • Change in role from hip extender to knee flexor • Fatigue, posture, leg length discrepancy, lack of flexibility, strength imbalances • Grade 2 - partial tear, identified by sharp snap or tear, severe pain, and loss of function

36. Signs of Injury • Muscle belly or point of attachment pain • Capillary hemorrhage, pain, loss of function, and possible discoloration • Grade 1 - soreness during movement and point tenderness • Grade 2 – increase pain, swelling, palpable swelling/defect? • Grade 3 - Rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap

37. Care • RICE • Restrict activity until soreness has subsided • Ballistic stretching and explosive sprinting should be avoided initially

39. Acute Femoral Fractures • Cause of Injury • Generally involves shaft, requires great force • Occurs in middle 1/3 due to structure and point of contact • Signs of Injury • Shock, pain, swelling, deformity • Must be aware of bone displacement and gross deformity • Loss of function

40. Care • Treat for shock, verify neurovascular status, splint before moving, reduce following X-ray • Secure immediate emergency assistance and medical referral

41. 8 foot fall

42. Femoral Stress Fractures • Cause of Injury • Overuse • Females who are amenorrheic are more vulnerable to stress fx • Signs of Injury • Persistent pain in thigh • X-ray or bone scan • Commonly seen in femoral neck • Management • Analgesics, NSAID’s RICE • ROM and PRE exercises are carried out w/ pain free ROM • Rest, limited weight bearing

44. Hip, Groin, and Pelvic Injuries • Groin Strain • Cause of Injury • One of the more difficult problems to diagnose • Early part of season due to poor strength and flexibility • Running, jumping, twisting w/ hip external rotation or severe stretch

45. Signs of Injury • Sudden twinge or tearing during active movement • Produce pain, weakness, and internal hemorrhaging • Care • RICE, NSAID’s and analgesics for 48-72 hours • Determine exact muscle or muscles involved • Rest is critical • Restore normal ROM and strength -- provide support w/ wrap • Refer to physician if severe groin pain is experienced

46. Sprains of the Hip Joint • Cause of Injury • Result of violent twist due to forceful contact • Force from opponent/object or trunk forced over planted foot in opposite direction • Signs of Injury • Signs of acute injury and inability to circumduct hip • Pain in hip region, w/ hip rotation increasing pain

47. Care • X-rays or MRI should be performed to rule out fx • RICE, NSAID’s and analgesics • Depending on severity, crutches may be required • ROM and PRE are delayed until hip is pain-free

48. Dislocated Hip • Cause of Injury • Rarely occurs in sport • Result of traumatic force directed along the long axis of the femur • Signs of Injury • Flexed, adducted and internally rotated hip • Palpation reveals displaced femoral head, posteriorly • Serious pathology • Soft tissue, neurological damage and possible fx

49. Care • Immediate medical care (blood and nerve supply may be compromised) • Contractures may further complicate reduction • 2 weeks immobilization and crutch use for at least one month

50. 7 y/o posterior hip dislocationskate board fall