Chapter 13 Hip, Pelvis, and Thigh Injuries

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Chapter 13Hip, Pelvis, and Thigh Injuries
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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

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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.

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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

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Anatomy of the Thigh

• Pelvis
• Ilium
• Ischium
• Pubis

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Muscles of the Hip

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

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Muscles of the Hip

• Hip Extensors
• Hamstrings
• Biceps femoris
• Vastus lateralis
• Vastus medialis
• Gluteus maximus

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Muscles of the Hip

• Abductors
• Gluteus medius
• Gluteus minimus
• Tensor fascia latae

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Muscles of the Hip/Thigh

• Medial Thigh Muscles (Groin)
• Primary function adduction
• Gracilis
• Adductor magnus
• Adductor brevis
• Adductor longus
• Pectineus

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Thigh Injuries

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

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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

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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...

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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

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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

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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

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Femur Fractures
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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

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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

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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

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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

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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

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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

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Hip snapping
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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

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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

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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

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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

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Groin Strains and Avulsions
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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

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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

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Hip, Thigh, and Groin Stretches
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Hip, Thigh, and Groin Stretches