Chapter 13 Hip, Pelvis, and Thigh Injuries

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

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.

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

Anatomy of the Thigh Pelvis Ilium Ischium Pubis

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

Muscles of the Hip Hip Extensors Hamstrings Gluteus maximus Biceps femoris Vastus lateralis Vastus medialis Gluteus maximus

Muscles of the Hip Abductors Gluteus medius Gluteus minimus Tensor fascia latae

Muscles of the Hip/Thigh Medial Thigh Muscles (Groin) Primary function: adduction Gracilis Adductor magnus Adductor brevis Adductor longus Pectineus

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

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

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...

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

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

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

Femur Fractures

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

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

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

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

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

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

Hip snapping

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

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

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

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

Groin Strains and Avulsions

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

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

Hip, Thigh, and Groin Stretches

Hip, Thigh, and Groin Stretches