H

IP AND

T

HIGH

Common Injuries

S TRAINS

  Quad, Hip Flexor, and groin strains commonly occur from explosive movement c/o “popping” or “pulling” feeling. Typically athlete can not continue activity.

 Strains that RTP too soon, or are left untreated with RTP can result in avulsion fx

 Signs and Symptoms  Pain, swelling, decreased ROM secondary to pain  Treatment  Rest, ice, ROM activities, electrical stimulation for tissue regeneration, Progressive Resistive Strength Training

C ONTUSIONS

 Quadriceps Contusion  Results from a traumatic or repetitive impact to a relaxed quad muscle, compressing the muscle against the femur

 Quadriceps Contusion Cont’d  Signs and Symptoms –  Pain, temporary loss of function, capillary bleeding, swelling, pain to the touch  Treatment –  Immediately placed in flexion to stretch the muscle (to prevent shortening), with ice pack to minimize swelling/bleeding and moderate pain. RICE and NSAIDs prescribed as needed  ROM (mild stretching), WBAT, and PRE within pain free ROM  Heat, aggressive massage, and ultrasound are all contraindicated

 Hip Pointer –   Occurs from a blow to an inadequately protected hip musculature) (iliac crest and abdominal Considered one of the most debilitating and hard to manage injuries in contact sports.

 Hip pointer cont’d  Signs and Symptoms –  Immediate pain, spasms, temporary paralysis of muscles. As a result, Ath is unable to rotate trunk, or flex the thigh without pain.

 Treatment –    RICE Ice cup massage Initially, steroid injection to manage pain, followed by oral NSAIDs  Recovery 1 to 3 wks  MOI is same as Iliac crest fx, Ath must be seen for Xray to RO

M YOSITIS O SSIFICANS

 Occurs from a severe blow or repeated blows to quadriceps muscle.  Failure to control initial bleeding from quad contusion, or tx that it too aggressive can produce calcification in the muscle.

 Signs and Symptoms –  Pain, weakness, soreness, swelling, decreased ROM  Treatment –  Sx excision 1 yr post injury.

F EMORAL F RACTURE

 Acute –  Occurs in middle aged athletes, and elderly patients.   Osteoporosis is a pre-disposing condition High incident of Avascular Necrosis in adolescent patients due to skeletal immaturity and inadequate blood supply  Fx w/o obvious deformity: c/o pain, no ROM, inability to WB. Ath is muscle-gaurding and resists any attempts to be moved.

  Hip is often EXTERNALLY rotated and slight adducted.

Shortening of the limb is sometimes evident.

F EMORAL F X

 http://www.youtube.com/watch?v=rO_nSjF_Jl0

F EM F X CONT ’ D

F EM FX CON ’ T

 Treatment –   Immobilized and transported for immediate medical care. Physician will either do a close reduction, or open reduction, depending on placement of fracture and number of fracture sites.

 ORIF (open Reduction Internal Fixation) requires pins and rods Following surgery, ath will be immobilized in hinge brace and will require PT.  Rehabilitation typically takes 4 months

F EM FX CON ’ T

 Stress fracture  Fairly uncommon, occurring most often in endurance athletes, and are more common in FEMALE athletes  (MOI Overuse)  Signs and symptoms –  Pain in groin or anterior thigh, pain increasing during activity; pain may be referred to knee. Positive Trendelenburg’s sign. Early x rays may not show fracture.

 Treatment –  Complete rest with calcium and Vitamin D supplementation. Untreated stress fx can result in displaced femoral fx, then requiring sx

L EG L ENGTH DISCREPANCY

  Simply put: one leg is shorter than the other  In non-active individuals, a LLD of 1” will produce symptoms. In highly-active individuals, an LLD of 1/8” will produce symptoms.

3 types:  True (Anatomical)   Apparent Functional

LLD C ONT ’ D

 True: Either Femur or Tibia is shorter when compared bilaterally. In some cases BOTH Femur and Tibia are shorter.  To Measure: Ath is supine, measurements taken from medial malleoli to ASIS   Apparent: Not a true LLD. Bone length is the same when measured. Apparent shortening is caused by pelvic rotation. Can be fixed/treated.

Functional: Deformity in bone causes LLD, such as Genu Valgum/Genu Varum (bow-legged, Pigeon-toed). Can not be fixed. Measurements taken from medial malleoli to umbilicus

Left: Genu Valgum (Knock-kneed) Bottom: Genu Varum (bow-legged)

T ROCHANTERIC B URSITIS

Inflammation of the bursae caused by friction from the muscle or tendons surrounding the area.

Signs and Symptoms: c/o P in lateral hip which may radiate down to knee. TTP over greater trochanter. AT must r/o ITB tightness Treatment: RICE, NSAIDS, ROM, and PRE. Avoid running on inclined surfaces. LLD and female athletes w/ increased Q-angle are more at risk

H IP D ISLOCATION

 https://www.youtube.com/watch?v=vXLLdU8-jO8  MOI: Traumatic force along axis of femur when knee is flexed.

 Can displace anteriorly or posteriorly. Posterior dislocation are more common.

 Posterior dislocations cause femoral shaft to adduct and flex

H IP D ISLOC CONT ’ D

 Signs and Symptoms:  Presents with a flexed, adducted, and internally rotated femur, extreme pain and no ROM available  Treatment:  Immediately reduce by medical professional. Immobilize and rest for 2 weeks. Use of crutches for ambulation approx 4 weeks  Complications:  Serious tearing to capsular ligaments, fracture to femur (head or neck) Sciatic Nerve damage, later development of osteoarthritis, avascular necrosis of femoral head due to interrupted blood supply

H IP R EDUCTION

 http://www.youtube.com/watch?v=sGQZaqB48rw

H IP DISLOCATION O VERVIEW

 https://www.youtube.com/watch?v=mAL-Szu7qAc

H IP L ABRAL TEAR

 MOI:  Commonly from overuse – running and cutting; can occur acutely from hip dislocation

H IP L ABRAL TEAR CONT ’ D

 Signs and Symptoms  Most often asymptomatic. Occasionally: catching, locking, or clicking, pain in the hip or groin, and feeling stiff or having decreased ROM  Treatment:  Hips strengthening and proprioception, avoiding movements that cause pain, NSAIDs, injections of corticosteriod. If pain persists longer than 4 weeks, sx considered to removed or repair

L EGG -C ALVE -P ERTHES DISEASE

 Avascular necrosis of the femoral head   Occurs in boys more than girls Occurs in ages 4 to 10  Etiology not always understood. Trauma only accounts for 25% on cases (femoral fx/hip dislocation)  Signs and Symptoms:  Pain in groin, abdomen or knees. Limping is common. Evaluations will only show limited ROM and pain. MRI/Xray needed

L EGG -C ALVE -P ERTHES DISEASE CONT ’ D

 Treatment:  Complete bed rest. If treated in time, femoral head could re-vascularize and re-ossify  Complications:  Head of the femur will become ill-shaped and cause osteoarthritis in the future

S LIPPED C APITAL F EMORAL E PIPHYSIS

 MOI: idiopathic potentially related to a growth hormone    Mostly seen in boys, ages 10-17 Tall and thin, or obese Trauma only account for 25% of cases (femoral fx/hip dislocation)  Signs and Symptoms:  Similar to those of LCP  Treatment:   Minor slippage: rest and NWB may prevent further slippage Major displacement: corrective surgery required

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LAST ONE!

S NAPPING H IP S YNDROME

 ITB moving over the greater trochanter of the femur  Excessive repetitive movements found in athletes such as dancers, gymnasts, hurdlers, and sprinters – creates a muscle imbalance  Signs and Symptoms:  Pain, with a visible “clunk” while patient re-enacts motion  Treatment:  Decrease inflammation and pain with ice, NSAIDs, stretching and strengtheing

S NAPPING H IP S YNDROME

 https://www.youtube.com/watch?v=SUXOqfT2zC 4