Chapter 13 Hip, Pelvis, and Thigh Injuries

1. Chapter 13Hip, Pelvis, and Thigh Injuries

2. The Hip, Pelvis, and Thigh • Includes some of the strongest muscles in the body. • Subjected to tremendous demands. • Extremely vulnerable to injuries that can sideline a player for an extensive period of time

3. Anatomy of the Hip and Pelvis • The hip joint is a ball-and-socket joint that allows motion and provides stability needed to bear body weight • The socket area, which is inside the pelvis, is called the acetabulum. The ball part of this joint is the top of the leg bone (head). It joins with the acetabulum to form the hip joint.

4. Anatomy of the Thigh • Bones • The femur • Designed to permit maximum mobility and support during movement • Longest and strongest bone in the body • Extends from the hip to the knee • The head of femur articulates with the pelvis to form the hip joint

6. Anatomy of the Thigh • Pelvis • Ilium • Ischium • Pubis

7. Muscles of the Hip • Most powerful in the body • Hip Flexors • Rectus femoris • Sartorius • Iliopsoas • Psoas major • Psoas minor • iliacus

8. Muscles of the Hip • Hip Extensors • Hamstrings • Biceps femoris • Vastus lateralis • Vastus medialis • Gluteus maximus

9. Muscles of the Hip • Abductors • Gluteus medius • Gluteus minimus • Tensor fascia latae

10. Muscles of the Hip/Thigh • Medial Thigh Muscles (Groin) • Primary function: adduction • Gracilis • Adductor magnus • Adductor brevis • Adductor longus • Pectineus

11. Thigh Injuries • Very few sprained ligaments or dislocations in this area • Proper flexibility and strength prevents most hip injuries • Proper equipment also important

12. Thigh Injuries • Quadriceps Contusion • Symptoms & Signs • Caused by sharp blow to thigh • Severe impact from relaxed thigh (muscle to femur) • Extent of force and degree of thigh relaxation determines depth of injury • Feels like a muscle bruise • Produces intense pain and weakness • Grades 1 - 4 depending on severity of injury

13. Thigh Injuries • Management • RICE • Use elastic bandage for pressure and support in the quadriceps area • Constant stretching of quadriceps muscle • Do not exercise if pain is still occurring • Begin slowly with swimming, jogging, etc...

14. Thigh Injuries • Myositis Ossificans (bone growth in muscle) • Symptoms & Signs • Pain, muscle weakness, soreness, swelling, decreased muscle function, ROM • Caused by multiple blows to the muscle area • A single severe blow • Improper care of a contusion • Management • PRICE • Do not ignore quadriceps contusions • Remove surgically after one year

15. Thigh Injuries • Quadriceps & Hamstring Strains • Symptoms & Signs • Pain, discomfort, point tenderness, spasms, soreness • Grade 1 = mostly spasms, grade 3 = rupture of tendon/muscle tissues • Strains tend to reoccur because of scar tissue that forms during the healing process • Management • PRICE, NSAIDS, analgesics • Cryotherapy • Preventative – stretch, warm up, use proper form

16. Thigh Injuries • Stress Fractures and Femur Fractures • Symptoms & Signs • Stress fracture – femur bends slightly, pain and discomfort from pounding of lower extremity (running) • Femur Fracture – severe pain, loss of function, internal bleeding, swelling • Management for stress fracture: • Rest • An alternative activity -Management for femur fracture: • Immobilization, once at hospital traction splint may be used to pull femur and reduce pain

17. Femur Fractures

18. Anatomy of the Hip and Pelvis • Bones • Ilium • Broad, flaring portion of hip bone • Crest of the pelvis • Pubis • Lower, posterior part of hip bone • Ischium • Helps to form the hip

20. Hip injuries • Hip Pointer • Injury to the iliac crest • Can be as minimal as contusion or as major as an avulsion fracture • Can be very painful and debilitating

21. Hip Injuries/Conditions • Legg-Calve-Perthes Disease • A disruption of blood flow to the head of the femur • The 'ball' of the 'ball and socket' joint dies • Usually is seen in children 2 to12 years of age, five times more common in boys than girls • Characterized by extreme pain in groin and knee area, or walking with limp

22. Hip Injuries • Dislocation of hip – Femur pops out of the socket (acetabulum) • Causes • Athletic injuries • Car accidents • Severe falls • Signs & Symptoms • Extreme pain • Leg is often internally rotated • Possible loss of feeling in foot or leg due to nerve damage • X-Ray or position of leg usually determines this injury

25. Hip Injuries - Dislocation • Management • Call ambulance immediately, hospital will relocate hip • Months of rehab needed – very long process • Begin with normal ROM and strength • May need to learn how to walk again

26. Hip injuries - Snapping Hip • The snapping hip – The IT band snaps over the greater trochanter hip stability becomes lessened and ligaments and adductor muscles become less stable. - Causes • Habitual movements that predispose muscles around the hip to become imbalanced • Greater range of motion of hip abduction • Dancers, gymnasts, hurdlers – structurally narrow pelvic width • Signs & Symptoms • Snapping occurs when balancing on one leg • Pain and inflammation with the snapping

27. Hip snapping

28. Hip injuries – Hip snapping • Management • Cryotherapy • Ultrasound to stretch tight muscles and strengthen weak muscles in the hip region • Resume activity when the pain subsides

29. Slipped Capital Femoral Epiphysis • The head of the femur slips off of the neck or shifts position • Found mostly in boys between 10 -17 who are tall & thin or obese • May be related to the effects of a growth hormone • Signs & Symptoms • Pain in the groin, limping • Hip and knee pain during passive and active motion

31. Avascular Necrosis • Temporary or permanent loss of the blood supply to the proximal femur. - Causes • Without blood, the bone tissue dies and causes a collapse of the joint surface. • Use of steroids can cause AVN - Signs and Symptoms • No symptoms in the early stages • Joint pain, at first during activity, then during rest • Osteoarthritis may develop after a period of time

32. Avascular Necrosis • Management • See physician for an MRI, X-ray, or CT scan • Electrical stimulation, ROM exercises, reduce weight bearing activity • Surgery will eventually be required to repair the joint

33. Groin Strains and Avulsions

34. Groin Strains • Groin strains usually involve the adductor group (especially adductor longus) • Causes • Running, jumping, or twisting with external rotation • Sports that require stretching of the hip • Rapid changes in speed or direction (soccer) • Signs & Symptoms • Complete rupture of the muscles that attach the pelvis bone to the femur bone. • Pain, weakness, and internal hemorrhage • A sudden twinge or feeling of tearing

35. Groin Strains • Management • RICE, NSAIDs, anagelsics for 48 – 72 hours after injury occurs • Rest • Daily whirlpool therapy or cryotherapy • Ultrasound • Gradual stretching to restore ROM • Protective spica bandages can be worn or Sawa groin & thigh braces

36. Hip, Thigh, and Groin Stretches

37. Hip, Thigh, and Groin Stretches