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Thigh, Hip and Pelvis. Joints are rarely injured in sport Soft tissue is commonly injured Bony Structure Femur Pelvis Sacrum and Coccyx. Pelvis. Iliac Crest ASIS and PSIS Ischial tuberosity Innominate Bone- Consist of: Ilium Ischium Pubis. Hip Joint. Ball and Socket Joint
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Thigh, Hip and Pelvis • Joints are rarely injured in sport • Soft tissue is commonly injured • Bony Structure • Femur • Pelvis • Sacrum and Coccyx
Pelvis • Iliac Crest • ASIS and PSIS • Ischial tuberosity • Innominate Bone- Consist of: • Ilium • Ischium • Pubis
Hip Joint • Ball and Socket Joint • Head of the femur- Convex • Acetabulum of the pelvis- Concave • Highly Stable from a bony perspective; several very strong ligaments that aid in keeping the head of femur in the acetabulum • Bursae • Iliopsoas bursa • Deep trochanteric bursa
Nerves and Blood Supply • Nerve supply • Lumbar plexus (L1 – L4) - forms the femoral nerve • Sacral Plexus (L4 – S4) – forms the sciatic nerve • Blood supply • Femoral artery
Muscles and Movements • Hip flexion • Normal ROM • 80 degrees knee straight • 120 degrees knee bent bent • Iliacus and psoas major (major flexors)- both form the illiopsoas- knee bent • Rectus femoris (function when knee is extended and with kicking the ball) • Sartorius • Hip Extension • Normal ROM 10 – 20 degrees • Hamstrings, gluteus maximus
Muscles and Movements (2) • Abduction • Normal ROM • 45 degrees • Gluteus medius • Adduction • Normal ROM • 30 degrees • Adductor magnus, longus, brevis, and gracilis
Muscles and Movements (3) • Internal Rotation or Medial Rotation • Normal ROM • 45 degrees • Glueteus Minimus and Tensor Fascia Latae • External Rotation or Lateral Rotation • Normal ROM • 45 degrees • 6 deep external rotators- piriformis
Quadriceps Contusions • MOI: direct blow • HOPS • Pain, swelling and ecchymosis • Walk with a limp • Palpable hematoma, with heat • Tx • Ice in stretched position, crutches if needed, wrap, See field strategy 10.2 (pg. 352), refer for x-ray
Myositis Ossificans • Accumulation of mineral deposits (bone) in muscle tissue • MOI: Single severe blow, repeated blows to muscle, mismanagement of contusion • HOPS • Firm swollen area in muscle • Palpable mass • Limited knee flexion • Active contraction of muscle difficult • Tx • Refer to physician (surgery may be needed)
Hip Pointer • Contusion caused by direct compression to the iliac crest • MOI: Direct blow • Hops • Pn with rotation, trunk flexion • Ecchymosis, pain, swelling, • Point tender over illiac crest • TX • RICE, refer for x-ray, donut pad and hard outer shell, to protect
Bursitis • Most common = trochanteric bursitis • MOI: overuse • HOPS: • Deep achy pain in lateral thigh • Pn with resisted abduction • TX • Heat, stretch abductors, Ultrasound • If condition does not resolve: refer to physician
Hip Sprains/ Dislocations • MOI: violent twisting/ severe trauma; rare in sports • HOPS: S/S with degree and type • Intense pain, • Inability to walk or move hip • Hip flexed and internally rotated – Fig 10-12 • TX • Symptomatic with mild to moderate sprains • Medical emergency, summon EMS, check distal neurovascular status; treat for shock
Muscle Strains • Hamstring strains more probable than Quadriceps strains; Adductor strains are more common than Abductor • Hamstring Strains are most common • Precursors • muscle imbalances, tight muscles, improper warm-up, overuse, fatigue, dynamic overload
Muscle Strains (2) • HOPS-In isolated region in question • “twinge” or “pull” • Weakness on RROM testing • Limping; Ecchymosis • Pop is heard when severe; Palpable defect • Pain with passive stretch, and resistive motion • Treatment- Hip Flexor or Hip Adductor Wrap; RICE, E-Stim, Strengthening/Stretching, NSAID’s; crutches if necessary
Muscle Strength Testing • 5 (normal) full strength against resistance • 4 (good) partial strength against resistance • 3 (fair) ability to move the body part no resistance • 2 (poor) able to contract muscle • 1 (trace) no evidence of contractility
Legg-Calve-Perthes Disease • Avascular necrosis (decreased blood supply to the head of femur) of the proximal femoral epiphysis-Fig 10-13 • Precursors: young males 3-8 years old • HOPS: • Gradual onset of pain in hip/groin or knee with no explanation • Gradual onset of a limp; • Decreased range of motion in the hip- AB, EX, ER • TX: refer to physician if unexplained hip, thigh or knee pain last for more than a week.
Avulsion Fractures (1) • Precursors: • Individuals who perform rapid acceleration/ deceleration • Locations: • ASIS: Sartorius • AIIS: Rectus Femoris • Ischial tuberosity: hamstrings
Avulsion Fractures (2) • HOPS • Sudden acute localized pain • Pain, swelling, discoloration over area • Pain with resisted stretching of the involved muscle • TX • Hip Spica Wrap if able • Fit for crutches • Refer to physician
Slipped Femoral Epiphysis • Epiphyseal/ Growth Plate fracture- Fig 10-15 • Precursor: Adolescent boys ages 8 – 15, obese or slender rapidly growing boys • HOPS: • Painful limp • Pain in the groin, anterior thigh or knee • Unable to internally rotate femur • Unable to stand on injured leg • TX: Refer to physician, surgery
Stress Fractures • Precursor: Box 10-3 • Common locations • Pubis • Femoral neck • Proximal 1/3 of femur • HOPS • Aching pain in groin or thigh during WB • Pn relieved by rest • Night pain • TX: Refer to physician
RROM testing • Hip Flexion • Hip Extension • Hip Abduction • Hip Adduction • Hip Internal Rotation • Hip External Rotation • Knee Extension • Knee flexion
Measuring for Leg Length • ASIS • Medial Malleolus • Patient Position: • Lying on table, pelvis square and balanced • Legs parallel • Heels approximately 6-8 inches apart
Special Tests • Thomas Test = Hip flexion contractures • Kendall Test = Hip flexion contractures (Rectus Femoris) • Straight Leg Raise=Disc Lesions or tight hamstrings • Pelvic Rock Test=Pelvic Fracture/SI Joint Sprain • Trendelenburg’s Test
Specialized Rehab • SLR’s- all 4 planes • Quad Sets/Glute Sets/Ham Sets • Stretching • Strengthening • Electrical Stimulation, US, Massage