Transcript Injuries to Hip and Thigh

Anatomy &
Injuries to the
Thigh, Hip and
Pelvis
General Information about the
pelvis
 This
area of body is strong and stable
 Great demand placed on this part of
body—”core”
 Functions:




support the spine & trunk
Transfer weight to lower extremities
Place for muscle attachment of thigh and
trunk
Protect organs of pelvic region
Anatomy
 Bones
 Muscles
 Ligaments
Bones

Femur
 Head,
neck, greater trochanter,
lesser trochanter, shaft, medial &
lateral condyle and epicondyles

Pelvis
 Ilium:
iliac crest, ASIS, AIIS, PSIS
 Ishcium: ischial tuberosity
 Pubis: Pubic symphysis
 Acetabulum
Bones-the anterior femur
The posterior femur
The pelvis
Muscles
 Hip
Flexors:
 Iliacus & psoas major=
Iliopsoas
 Rectus femoris
 Sartorius
 Hip Extensors:
 Hamstrings-biceps
femoris,
semitendinosus,
semimembranosus
 Gluteus maximus
Muscles
 Knee

Hamstrings, gastrocnemius
 Knee

flexors:
extensors:
Quadriceps—rectus femoris, vastus lateralis,
vastus medialis, vastus intermedius
Muscles
Muscles
Muscles
 Hip

Adductor magnus, adductor longus,
adductor brevis, (Adductors) gracilis,
pectineus
 Hip

Adductors:
Abductors:
Gluteus medius, tensor fascia latae
Muscles
Muscles
 Hip

Tensor fascia latae, gluteus minimus
 Hip

Internal rotators:
External rotators:
Gluteus maximus, gluteus medius, piriformis
Ligaments
 Thickening
joint
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of joint capsule allows for very stable
Iliofemoral
Ischiofemoral
pubofemoral
 Ligamentum


Teres
Also called the round ligament
Attaches head of femur into acetabulum allowing
blood supply to that area
Ligaments
Hip Movements
Hip
Flexion
Preventing injuries to thigh/hip
 Flexibility
training and stretching
 Strength training
 Proper protective equipment
Common Injuries
 Strains
 Sprains
 Contusions
 Fractures
 Dislocations
Strains
 Quads
 Hamstrings
 Groin
(adductors)
 Hip flexors
 Gluteals
Strains
 MOI:
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sudden strong contraction of muscle(s)
overstretching of muscle(s)
Muscle strength imbalance
Strains-hamstring
Strains- groin
Strains
 S/S:
pain/discomfort
 Pt. tender
 Bleeding causing discoloration (after 1-2
days)
 Loss of function
 Muscle spasm
 deformity
Strains
 TX:
RICE
 modify/restrict activity
 crutches if necessary
 Medical referral if necessary
 Restore normal ROM flexibility and
strength using various modalities as
needed
Strains
 Complications:
 recurrent
strains due to “inelasticity
of scar tissue” especially at that
same site
 Excess buildup of scar tissue
Strains-quad after the fact
Strains-quad
Strains-hamstring
Strains-hamstring
Hamstring strain treatment
Hamstring avulsion
HAMSTRING WRAP
 6”
Double ACE wrap
 Start around the leg and work your way
around the waist.
 Pulling the leg into extension.
 Athlete
is standing with injured leg out in
front.
 Athlete’s injured leg has a roll of tape
underneath the heel, to slightly flex the
muscles.
Groin Wrap
 6”
Double ACE wrap
 Start around the leg and work your way
around the waist.
 Pulling the leg into adduction.
 Exact same set up as
hamstring wrap.
Contusions
 Quadriceps
 Hip
pointer
Quadriceps Contusion
 MOI:

direct blow to relaxed thigh compressing
the musculature again the femur
Quadriceps Contusion
 S/S:
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Pain
Pt. tender
Bleeding into the
muscle
Swelling
Temporary loss of
function
Quad contusion
 Tx:
RICE w/ knee flexed
 Crutches if necessary
 Restore normal ROM, flexibility & strength
 Ultrasound
 Heat
 Medical referral if needed
Quad contusion
 Complication:

Myositis ossificans—formation of bony tissue
within the muscle
 Very
painful
 Greatly restricts ROM mainly flexion

Caused by:
 severe
blow that is not properly cares for
 Repeated blows to same area
6
Quad Contusion Wrap
or 4” Single wrap
 Contusion Pad/Foam
 Athlete
has heel on roll of tape.
 Place foam or contusion pad over the
affected area. Use the elastic wrap
starting distal to proximal to cover the
foam or pad.
Myositis Ossificans
Hip Pointer
 MOI:

direct blow to the iliac crest and/or ASIS
 S/S:
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Pain
Spasm
Bleeding in the area—discloration
Temporary loss of motion
 Unable
to rotate trunk or flex hip without pain
Hip Pointer
Hip Pointer
 Tx:
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RICE
Bed rest if necessary
Medical referral if necessary
Return to activity when pain if gone and
motion is restored
Fractures-Avulsion
 Most
 MOI:
common at ASIS or Ischial Tuberosity
forceful contraction of muscle
Avulsion Fractures
 S/S:
 Extreme
pain with movement & weight
bearing
 Pt. tender (either over the ASIS or Ischial
tub.)
 Bleeding/discoloration
Avulsion
 TX:
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Ice
crutches
Medical referral for x-ray
Fractures- femur
 Occurs
femur
most often in the shaft of the
 MOI:

great force-direct or indirect- placed on
the femur
Femur Fractures
 S/S:
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Pain
Pt. tender
Deformity w/ thigh externally rotated, shortened
Loss of motion/function
Swelling due to internal bleeding
Muscle spasms
Muscle lacerations
Femur fractures
 Can
be life threatening—fatty tissue and
bone marrow can get into the blood
stream and cause a blood clot
Femur Fracture
 Tx:
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Call 911
Don’t move the athlete
Hare traction splint
Check for distal pulse
Control any external bleeding
Treat for shock
Femur fractures
Femur fractures
Femoral Stress Fracture
 MOI:
repetitive stress of the pounding of
the lower extremity which causes the
femur to bend (one side is compressed
the other is stretched)
Femoral stress fracture
 S/S:
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Pt. tender at one specific site
Pain with activity
Pain with a compressive force at the site
(sitting on edge of table)
Pain with activity
Femoral Stress fracture
 Tx:
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Rest
Alternate activity—non-weight bearing
Crutches if limping
Medical referral---x-rays and bone scan or--
Femoral stress fx
Slipped Capital Femoral
Epiphysis
 Growth
plate injury (epiphyseal fracture)
 Occurs at the capital femoral epiphysis
(where neck joins the head of femur)
 More common in boys 10-17 yrs.
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
Tall and thin
obese
Slipped Capital femoral
epiphysis
 MOI:
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Not know but may be related to effects of
a growth hormone
In ¼ of cases both hips are affected
Slipped---epiphysis
 S/S:
 Pain
in groin area that
 arises suddenly as a result of trauma
 arises slowly over weeks or months as a result of
prolonged stress
 Early signs minimal but later get pain in hip and
knee
 Major limitations with movement
 Limp when walking
Slipped --- epiphysis
 TX:
 Minor
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Rest
Non-weight bearing to prevent further slippage
Medical referral
 Major
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cases
cases
Surgery to repair “fracture” usually put pins into bone
to keep in place and allow for proper healing
Slipped---epiphysis
 Complications:
 If
displacement goes
undetected or if surgery
fails to restore normal hip
mechanics can have
problems later in life
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Bone doesn’t grow
properly
Head of femur doesn’t
grow properly
Bone spurs
Arthritis
SCFE
SCFE
SCFE
 Pins
to fix
Legg-Calve-Perthes Disease
 Disruption
of blood flow to the head of femur
causing the bone tissue to die and become
flattened
 Occurs in children 3-12 yrs
 Occurs in boys 4 times more often than girls
 Usually occurs in first born
 Affect usually only one hip
LCPD
 MOI:
Unknown
 S/S:
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
complaints of pain in groin, and sometimes
referred pain to abdomen or knee
Limited hip movement
LCPD
 Tx:
 Medical
referral
 Bed rest or non-weight bearing
 If treated in time, the head of femur will
revascularize and regain its normal shape (the old
cells that die will be resorbed and new bone cells
laid down to take their place)
LCPD
LCPD
 Complications:

If not treated early enough, the head of
femur will be ill (abnormally) shaped
producing osteoarthritis in later life
Hip Dislocation
 Rarely
occurs in sports
 Most are posterior
 MOI:
traumatic force along the long axis of the
femur such as falling on one side with the knee bent
(and landing on that bent knee) forcing head of
femur posteriorly
Hip Dislocation
 S/S:


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Hip in flexion, adduction, and internal
rotation
Deformity posterior—head of femur can be
palpated through gluteal muscle
Extreme pain
Inability to move at hip joint
Hip Dislocation
Hip Dislocation
Hip Dislocation
 TX:
 Call
911
 Don’t move athlete
 Splint in position you find them
 Treat for shock
Hip Dislocation
 Complications:
 Tears
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
in the vascular and nerve structures
Blood vessels to ligamentum teres may be torn (as will
the ligament itself)
Sciatic nerve may be damaged
 Paralysis
of muscles in the area
 Atrophic necrosis (degeneration of femoral head)
Bo Jackson