Injuries of the Thigh, Hip, Groin & Pelvis Chapter 17 Injuries of the Thigh, Hip, Groin & Pelvis

Anatomy Femur Ossa Coxae Sacrum

Motions Internal Rotation: Gluteus Minimus External Rotation: Piriformis, Superior Gemellus, Inferior Gemellus, Obturator Internus, externus & femoris Flexion: Rectus Femoris, Sartorius, Illiacus, Psoas Extension: Hamstring group, Gluteus Maximus Adduction: Gracilis, Pectineus, Adductor magnus, Adductor Longus & Brevis Abduction: Gluteus Medius, Tensor Fascia Latae

Quadriceps Contusion Generally caused by a traumatic blow to the Quadriceps Characterized by severe pain, muscle weakness, limping, decreased ROM, swelling & discoloration Can be Grade1 Mild, Grade 2 Moderate, or Grade 3 Severe Treat with compression in knee flexion, cryotherapy (cold), very gentle stretching & PRICE

Quadriceps Contusion

Myositis Ossificans AKA Muscle Ossification Caused by a severe blow or repeated blows to a specific area. This trauma results in ectopic bone formation in the muscle tissue Causes a disruption of muscle fibers, blood vessels, connective tissue & bone periosteum More likely to occur in muscle belly vs. the origin or insertion Can be seen on X-ray as early as 2-4 wks following injury Treat contusions gently & not vigorously May require surgical removal

Quadriceps Strain Cause by a sudden stretch or sudden contraction Rectus femoris is the most commonly strained muscle in the group Characterized by pain, point tenderness, spasm, loss of function, decreased ROM, discoloration & edema Treat with PRICE, gentle stretching, strengthening & wrap for support Can be Grade 1, Grade 2 or Grade 3

Hamstring Strain Caused by quick change from knee stabilization to extension of the hip. Could also be caused by muscle fatigue, tight musculature, faulty posture, improper form, & imbalance between quadriceps strength & hamstring strength. Characterized by pain, point tenderness, spasm, loss of function, decreased ROM, discoloration & edema Treat with PRICE, gentle stretching, strengthening & wrap for support Can be Grade 1, Grade 2 or Grade 3

Acute Femoral Fracture Cause by direct trauma or falling from a great height Usually occur in the bone shaft Characterized by severe pain, deformity, bone displacement, shortened thigh, loss of function, immediate swelling & discoloration Secure Emergency Medical Services, stabilize the injury, but do not move the patient. This injury can be life threatening!

Stress Fracture of the Femur Caused by repetitive exercise & overuse. Athletes with sub-standard nutritional intake are more likely to suffer from this condition. Female athletes with lower estrogen levels due to menstrual irregularities are more prone to this injury. Characterized by constant increasingly severe pain. Occurs most often at the femoral neck. Treated with rest, limited weight bearing. ROM & strengthening may be gradually reintroduced. Re X-ray every 2 weeks to observe injury healing or lack there of.

Hip Sprain Cause: May result from a violent twist caused by impact with another player or forceful contact with another object Signs & Symptoms: Inability to circumduct the thigh, pain, swelling, bruising Care: X-ray to rule out fx., PRICE, Analgesic, Weight bearing as tolerated, PT for ROM & strength

Hip Flexor Strain Rectus Femoris, Sartorius, Illiacus, Psoas Cause: Injuries most frequently occur as a result of a strenuous hip flexing motion, such as when kicking a ball. It may also occur from over-stretching the muscle, which would involve a backward movement of the thigh. Signs & Symptoms: Pain at the front of the hip that develops suddenly. Pain is made worse by raising the thigh against resistance. Stretching these muscles may causes pain. It may be tender to touch the area at the front of the hip, although Iliopsoas is very deep so difficult to feel. Tenderness is more likely to indicate a Rectus Femoris injury. Swelling and bruising may occur in severe cases. Treatment: Rest from aggravating movements and activities until pain free. Apply Ice regularly. Once pain free to do so, start gentle hip flexor stretches. Strengthening may begin after 2-7 days depending on severity and pain levels. Isometric contractions should be used first - the muscles are contracted against resistance, without movement! These can be progressed provided they are pain-free.

Dislocated Hip Care: Immediate referral to ER. Immobilization of 2 weeks after reduction. Crutches for a minimum of 1 month. PT. Posterior hip dislocations present more serious problems such as paralysis, nerve damage or avascular necrosis Cause: Rare. Traumatic force along the long axis of the femur, athlete falling on his or her side Signs & Symptoms: Flexed, Adducted & IR Thigh. Palpable deformity. Often associated with a fracture. Nerve & arterial damage may also occur.

Dislocated Hip

Piriformis Syndrome Cause: Sciatic Nerve is compressed or irritated by tightness or muscle spasm Can mimic Sciatica which is caused by a herniated disc Signs & Symptoms: Pain, Numbness, tingling from buttocks to below knee. Pain may worsen with long bouts of climbing stairs, walking or running Care: Stretch, Massage, Anti- inflammatory drugs, Cessation of irritating activities, PT, Core strengthening

Groin Strain Cause: Overextension. Running, Jumping, & twisting with ER. Poor strength & flexibility. Signs & Symptoms: Pain, weakness, swelling, bruising, limited function Care: PRICE, crutches, light stretching, wrap, X- ray to rule out more serious injury

Groin Strain

Hip Pointer Cause: Falling on the hip or trauma. Soft tissue if pinched against bone. AKA Iliac Crest Contusion Signs & Symptoms: Loss of function, Pain, Swelling, Bruising, muscle guarding, transitory paralysis, pain with hip flexion or abdominal rotation Care: x-ray to rule out fx. Weightbear as tolerated, Ice, Anti-inflammatories, pad to return to play

Hip Pointer

Osteitis Pubis Cause: Noninfectious inflammation of the symphysis pubis. Repetitive stress caused by the pull of muscles caused chronic inflammation Common in distance runner, soccer, wrestling Signs & Symptoms: Pain with running, sit ups, & squats. Pain directly over symphysis pubis, & groin. Care: Rest, Anti- inflammatory drugs, gradual return to play. NO Ultrasound!!

Acute Pelvic Fracture Cause: Direct Trauma Signs & Symptoms: Severe pain, loss of function, shock. Care: Immediately treated for shock. Refer immediately for treatment. Surgery may be required. Be cautious of internal injury & minimize movement as much as possible.

Pelvic Stress Fracture Cause: repetitive abnormal overuse forces. More common during intensive training & competitive racing Signs & Symptoms: groin pain, aching thigh pain that increases with activity & decreases with rest Care: Refer for x-ray, REST for 2-5 months depending on how healing progresses. Repeat x-rays or required to monitor progress.

Avulsion Fracture Cause: sudden, forceful contraction Signs & Symptoms: sudden localized pain, limited movement, swelling, point tenderness, bruising. Care: Rest, limited activity & graduated exercise. Depending on the muscle, surgery may be required to repair.

Legg-Calve-Perthes Disease(Coxa Plana)

Slipped Capital Femoral Epiphysis