Injuries to the Hip and Pelvis

Skeletal anatomy of the hip/pelvis 1. Ilium – upper, lateral section of pelvis 2. Iliac crest – upper ridge of ilium 3. ASIS (Anterior Superior Iliac Spine) – identifies anterior end point for iliac crest 4. Ischium/Ischial tuberosity - weight bearing portion when seated 5. Acetabulum – concave surface of pelvis, articulation site of pelvis and femur

Review of anatomy of the hip and pelvis 6. Femoral neck – narrowed portion of proximal femur, leading to femoral head 7. Greater trochanter – larger protrusion on superior portion of femur 8. Lesser trochanter – smaller protrusion located on inferior/medial portion of femoral neck 9. Trochanter bursa – fluid filled sac that protects against friction along lateral aspect of hip

Muscular Anatomy of the Hip/Pelvis # Muscle Function 1 Psoas major Flexes, rotates thigh medially 2 Gluteus maximus Extends, rotates thigh laterally 3 Gluteus medius Abducts, rotates thigh medially 4 Gluteus minimus 5 Tensor fascia lata Assists with abduction, rotation

Muscular Anatomy of the Hip/Pelvis # Muscle Function 6 Abductor brevis Abducts, rotates thigh 7 Adductor magnus Adducts, extends thigh 8 Hamstrings Knee flexion, assist with hip extension 9 Quadriceps Knee extension, can assist with hip flexion

Hip Injuries and their Special Tests

Bursitis Basic Info: inflammation of bursa from excessive or repeated friction over greater trochanter; usually occurs from insufficient stretching/warm-up S/S: pt. tenderness over lateral hip, made worse by walking/running Tx: limit activity, rehab, ice massage, nsaids Rehab/RTP: will include LOTS of stretching and strengthening focused on mechanics/posture/gait; RTP- determined by PT, but dictated by symptoms

Fractures Basic Info: can occur to pelvic bone or to proximal femur, though not common in athletics; if does occur in athletics, will likely require EMS activation S/S: severe pain, abnormal rotation of leg, any movement will be painful Tx: Immediate referral to EMS, immobilization Rehab/RTP: Extremely slow progressing, will require ROM and functional strengthening prior to any sport specific training

Labral Tear Basic Info: Tear to “ring” of cartilage that edges the acetabulum; occurs from either injury or structural defect/abnormality S/S: pain in anterior / lateral hip; clicking, catching, locking feeling Tx: removal from play and referral to physician; ice, nsaids Rehab/RTP: extensive, slowly progressing rehab (very similar to fractures)

Hip Scouring Test Patient Position: Supine Examiner Position: At side of patient, fully flexing patient’s hip and knee Action: Apply downward pressure (axial loading); Internally and externally rotate femur at multiple angles of hip flexion Indication: Pain or reproduction of symptoms indicates possible labral tear Notes: none

Muscle Strains Basic Info: commonly occur to hip flexors, hamstrings, adductors, and groin; classified as either Grade I, II, or III S/S: pain, especially at end ROM; bruising over specific site; weakness with AROM and functional movements Tx: PRICE; NSAIDS Rehab/RTP: Critical to reduce risk of re-injury; will focus on strengthening; can take up to 10 weeks in severe cases.

Iliotibial Band Friction Syndrome (ITBS) Basic Info: Inflammation of the IT-band; usually result of muscle imbalance and with distance athletes. S/S: Pain can occur at either lateral hip or lateral knee; pain increases with activity and resolves with rest Tx: Ice, NSAIDS, reduction in activity level Rehab/RTP: will usually include gait analysis to find and correct mechanical errors causing problem; RTP usually only dictated by symptoms

IT Band Friction Syndrome

Ober’s Test Patient Position: Sidelying, affected side up; bottom hip/knee flexed to 90; affected side knee flexed to 90 Examiner Position: Standing behind patient, one hand stabilizing pelvis, opposite hand holding medial aspect of affected side knee Action: Passively abduct and extend hip; allow hip to passively adduct toward table Indication: Amount of adduction toward table indicates level of ITB tightness Notes: VERY IMPORTANT to maintain pelvic stabilization to avoid false-negative

Iliac Crest Contusion (aka Hip Pointer) Basic Info: Injury caused by direct trauma to the lateral hip; more common in contact sports S/S: extreme pt. tenderness, swelling, ecchymosis over iliac crest Tx: Ice and compression Rehab/RTP: usually fairly quick, dictated by symptoms; RTP will usually involve padding area

Trendelenberg Test Patient Position: Standing, weight evenly distributed between both feet, hands high on waist Examiner Position: Behind patient Action: Patient lifts leg (opposite of side affected) directly in front of them Indication: Lowering of pelvis on non-weight bearing side indicates glute weakness Notes: Test used mostly to determine patient’s risk or injury or to evaluate contributing factors v. any specific structural deficiency.

Ely’s Test Patient Position: Lying prone Examiner Position: Standing on affected side Action: Examiner passively flexes knee on affected side Indication: Hip flexion, causing it to lift off table indicates tightness of rectus femoris Notes: Test used mostly to determine patient’s risk or injury or to evaluate contributing factors v. any specific structural deficiency.

Thomas Test Patient Position: Lying supine, with lower leg off end of table (knees bent) Examiner Position: Standing on unaffected side Action: Examiner passively flexes leg on unaffected side Indication: Leg lifts off table = iliopsoas tightness; Leg extends at knee = rectus femoris tightness Notes: Test can be modified to isolate iliopsoas with body fully on table