Thigh, Hip and Pelvis

1
Thigh, Hip and Pelvis

• Joints are rarely injured in sport
• Soft tissue is commonly injured
• Bony Structure
• Femur
• Pelvis
• Sacrum and Coccyx

2
Pelvis

• Iliac Crest
• ASIS and PSIS
• Ischial tuberosity
• Innominate Bone- Consist of
• Ilium
• Ischium
• Pubis

3
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

4
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

5
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

6
Muscles and Movements (2)

• Abduction
• Normal ROM
• 45 degrees
• Gluteus medius
• Adduction
• Normal ROM
• 30 degrees
• Adductor magnus, longus, brevis, and gracilis

7
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

8
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

9
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)

10
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

11
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

12
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

13
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

14
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, NSAIDs
  crutches if necessary

15
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

16
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.

17
Avulsion Fractures (1)

• Precursors
• Individuals who perform rapid acceleration/
  deceleration
• Locations
• ASIS Sartorius
• AIIS Rectus Femoris
• Ischial tuberosity hamstrings

18
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

19
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

20
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

21
RROM testing

• Hip Flexion
• Hip Extension
• Hip Abduction
• Hip Adduction
• Hip Internal Rotation
• Hip External Rotation
• Knee Extension
• Knee flexion

22
Measuring for Leg Length

• ASIS
• Medial Malleolus
• Patient Position
• Lying on table, pelvis square and balanced
• Legs parallel
• Heels approximately 6-8 inches apart

23
Special Tests

• Thomas Test Hip flexion contractures
• Kendall Test Hip flexion contractures (Rectus
  Femoris)
• Straight Leg RaiseDisc Lesions or tight
  hamstrings
• Pelvic Rock TestPelvic Fracture/SI Joint Sprain
• Trendelenburgs Test

24
Specialized Rehab

• SLRs- all 4 planes
• Quad Sets/Glute Sets/Ham Sets
• Stretching
• Strengthening
• Electrical Stimulation, US, Massage