Chapter 17: The Thigh, Hip, Groin, and Pelvis © 2007 McGraw-Hill Higher Education. All rights reserved.

ASIS and AIIS – Sartorius and Rectus Femoris Attachments

Ischial Tuberosity – Hamstring Attachments

Muscles and Movements Hip flexion Hip Extension Normal ROM 120 degrees knee bent bent Iliacus and psoas major (major flexors)- __________________________ - knee bent _________________ (function when knee is extended and with kicking the ball) Sartorius Hip Extension Normal ROM 10 – 20 degrees ________________________________

Muscles and Movements (2) Abduction Normal ROM 45 degrees ________________ Adduction 30 degrees Adductor magnus, longus, brevis, and gracilis

Muscles and Movements (3) Internal Rotation or Medial Rotation Normal ROM 45 degrees _____________________________________________________ External Rotation or Lateral Rotation 6 deep external rotators- piriformis

RROM testing Hip Flexion Hip Extension Hip Abduction Hip Adduction Hip Internal Rotation Hip External Rotation Knee Extension Knee flexion

Special Tests Thomas test Test for hip contractures-______________ Straight Leg Raise Test for hamstring tightness or Can also be used to assess sciatic nerve irritation from swelling, bulging/herniated disk or SI joint dysfunction

Special Test Cont Kendall Pelvic Rock Trendelenburg’s Test

Prevention of Thigh Injuries Thigh must have maximum strength, endurance, and extensibility to withstand strain Dynamic stretching programs may aid in muscle preparation for activity Strengthen programs can also help in preventing injuries Squats, lunges, leg press Core strengthening

Recognition and Management of Thigh Injuries Quadriceps Contusions Cause of Injury Constantly exposed to traumatic blows Signs of Injury Pain, transitory loss of function, immediate bleeding of affected muscles Early detection and avoidance of internal bleeding are vital – increases recovery rate and prevents muscle scarring

Care RICE and NSAID’s ___________________________ ________________________________________________________________ Heat, massage and ultrasound to prevent myositis ossificans Padding may be worn for additional protection upon return to play

Myositis Ossificans Cause of Injury Signs of Injury Care _________________________________________________________________ Signs of Injury _______________________________________________________ Pain, weakness, swelling, decreased ROM Tissue tension and point tenderness Care Treatment must be conservative May require __________________ if too painful and restricts motion If condition is recurrent it may indicate problem with blood clotting

Quadriceps Muscle Strain Cause of Injury ____________________________________________________________________ Associated with weakened or over constricted muscle Signs of Injury Peripheral tear causes fewer symptoms than deeper tear Pain, point tenderness, spasm, loss of function and little discoloration Complete tear may leave athlete w/ little disability and discomfort but with some deformity; more discoloration; edema will settle in back of knee, calf and ankle Care – Fit for crutches if necessary _____________________________________________ Determine extent of injury early Neoprene sleeve may provide some added support

Hamstring Muscle Strains Cause of Injury Multiple theories of injury Hamstring and quad contract together Change in role from hip extender to knee flexor Fatigue, posture, leg length discrepancy, lack of flexibility, strength imbalances, Signs of Injury Muscle belly or point of attachment pain Capillary hemorrhage, pain, loss of function and possible discoloration Grade 1 - soreness during movement and point tenderness Grade 2 - partial tear, identified by sharp snap or tear, severe pain, and loss of function

Signs of Injury (continued) Grade 3 - Rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap Care RICE Restrict activity until soreness has subsided Ballistic stretching and explosive sprinting should be avoided initially Fit for crutches if necessary

Recognition and Management of Specific Hip, Groin, and Pelvic Injuries Groin Strain Cause of Injury One of the more difficult problems to diagnose Often seen in early part of season due to poor strength and flexibility Occurs from running , jumping, twisting w/ hip external rotation or severe stretch Signs of Injury Sudden twinge or tearing during active movement Produce pain, weakness, and internal hemorrhaging

Groin Strain (continued) Care ______________________________________________________________ Determine exact muscle or muscles involved ______________________ _______________________________________________________________ Refer to physician if severe groin pain is experienced Fit for Crutches if necessary

Sprains of the Hip Joint Cause of Injury Result of violent twist due to forceful contact ___________________________________________________________________________________ Signs of Injury Signs of acute injury and inability to circumduct hip Pain in hip region, w/ hip rotation increasing pain Care X-rays or MRI should be performed to rule out fx RICE, NSAID’s and analgesics Depending on severity, crutches may be required ROM and PRE are delayed until hip is pain free

Piriformis Syndrome Cause of Condition Signs of Injury __________________________________________________________________ _________________________________ Signs of Injury Pain, numbness and tingling in butt – may extend below knee and into foot Pain may increase following periods of sitting, climbing stairs, walking or running Care Stretching and massage NSAID’s may be prescribed Cessation of aggravating activities will be prescribed Corticosteroid injection may also be suggested Surgery is sometimes an option as well

Hip Problems in Adolescent Athletes Legg Calve’-Perthes Disease Cause of Condition Avascular necrosis of the femoral head in child ages 4-10 Articular cartilage becomes necrotic and flattens Signs of Condition Pain in groin that can be referred to the abdomen or knee Limping is also typical Varying onsets and may exhibit limited ROM

Legg-Calve’-Perthes Disease (continued) Care Bed rest to reduce chance of chronic condition Brace to avoid direct weight bearing Early treatment and head may reossify and revascularize Complication If not treated early, will result in ill-shaping and osteoarthritis in later life

Slipped Capital Femoral Epiphysis Cause of Condition May be growth hormone related 25% of cases are seen in both hips ________________________________________________________________________________________________ ___________________________________ Signs of Condition Pain in groin that comes on over weeks or months Hip and knee pain during passive and active motion; limitations of abduction, flexion, medial rotation and a limp Management W/ minor slippage, rest and non-weight bearing may prevent further slippage Major displacement requires surgery If undetected or surgery fails severe problems will result

Iliac Crest Contusion (hip pointer) Cause of Injury __________________________________________________________________ ____________________________ Signs of Injury Pain, spasm, and transitory paralysis of soft structures _________________________________________________________________________ Care RICE for at least 48 hours, NSAID’s, Bed rest 1-2 days in severe cases Referral must be made, X-ray Padding should be used upon return to minimize chance of added injury

Avulsion Fractures Cause of Injury _________________________________________________________________ Pulling of tendon away and off of bony insertion Common sites include ASIS (________), AIIS (___________________), ischial tuberosity (___________) Signs of Injury Sudden localized pain w/ limited movement Pain, swelling, point tenderness Care Rest, limited activity and graduated exercise