1. Injuries to Pelvis and Hip

2. Anatomy of Pelvis Bones of pelvic girdle
1. ilium
2. ischium
3. pubis
4. sacrum
** ilium, ischium, and pubis combined form the 2 pelvic bones
Articulations of pelvic girdle
1. sacroiliac joint
2. pubis symphysis

3. Pelvic Girdle
Anatomy Of The Pelvis

4. Major Muscles of Pelvis
1. Hip Flexion
Iliopsoas
Iliacus
Psoas Major
sartorius
quadricep muscles
2. Abduction
gluteus medius
gluteus minimus
tensor fasciae latae
3. Adduction
adductor longus
adductor magnus
adductor brevis
gracilis
pectineus
4. Hip Extension
hamstrings
gluteus maximus

5. Muscles of the Pelvic and Hip

6. Identification Identify the following: Illium Ischium Pubis Sacrum
Sacroiliac joint
Pubis symphasis
Iliac crest

7. Identification Identify the following: Psoas Major Iliacus
Tensor Fasciae Latae
Adductor Magnus
Adductor Brevis
Adductor Longus
Gracilias
Pectineus
Piriformis

8. Identification Identify the following: Gluteus Maximus Gluteus Minimus
Gluteus Medius

9. Blood Supply to Lower Extremities
Arteries
Iliac
femoral
popliteal
tibial
peroneal
Veins
iliac
femoral
saphenous
popliteal
tibial
peroneal

11. Blood Supply to Pelvis Pelvic Blood Supply Iliac artery Internal
External

12. Injuries to Pelvic Region
Fractures in Pelvic Region
Very rare in sports
Most common
1. stress
2. avulsion
Symptoms
1. altered gait
2. localized pain

13. Stress Fractures Stress Fx Small crack in bone Overuse injury
Uncommon in pelvic area (1 to 7% of reported stress fx)
Seen mainly in distance runners
More common in females

14. Stress Fractures Stress Fx Symptoms Diagnosis Treatment
Chronic pain in pelvis area
Gets worse with activity
Diagnosis
X-rays and bone scans
Treatment
Rest / no activity
Some may need crutches for few days

15. Stress Fracture

16. Avulsion Fracture Avulsion Fx
Piece of bone pulls away at tendon attachment site
Caused when muscle contracts too rapidly or quickly (sudden stops, starts or jumping)
Symptoms
May hear or feel a “pop”
Immediate pain
Decreased ROM
Limping

17. Avulsion Fractures Avulsion Fracture Treatment Incidences
4 to 6 weeks of rest
Physical Therapy
Incidences
Rare but seen in sports that require sprinting or rapid changes in movement
Basketball, track and soccer

18. Avulsion Fractures Can occur at many points along pelvis Iliac crest
Anterior superior iliac spine (ASIS)
Anterior inferior iliac spine (AIIS)
Ischial tuberosity
Pubic symphysis

19. Common Avulsion Fracture Sites

20. Avulsion fx of left ischium
Avulsion fx of anterior superior iliac spine

21. Avulsion Fracture

22. Hip Pointers Hip Pointers Blow to the iliac crest Causes bone bruise
Symptoms
Point tenderness along iliac crest/spine
Loss of ROM
Treatment
Rest
Ice
ROM exercises
Donut shaped padding

23. Hip Pointers

24. Hip Pointers

25. Injuries to Pelvic Region
Strains (Adductors or Hip Flexors)
Mechanism of Injury
1. extreme rotation
2. excessive abduction
Treatment
1. ice
2. stretch
3. leg strengthening

26. Anatomy of Hip and Thigh
Bones
1. Femur
2. Pelvic bone
Articulations (Hip Joint)
1. Head of femur
2. Acetabulum of pelvis
bone
** ball and socket joint

27. Bony Landmarks of Hip Hip Joint Acetabulum Femoral Head
“socket” for hip joint
Femoral Head
“ball” for hip joint
Greater trochanter
Lesser trochanter
Femoral neck
Femur

29. ROMS of Hip Joint Flexion Extension Abduction Adduction
Medial Rotation
Lateral Rotation

30. Major Muscles of Hip Hip flexion & Knee extension
Anterior thigh muscles
Quadriceps Group
rectus femoris,
vastus medialus,
vastus lateralis,
vastus intermedius

32. Major Muscles of Hip Hip extension & Knee flexion
Posterior thigh muscles
Hamstring Group –
Semitendinosus
Semimembranosus
Biceps femoris

35. Injuries to the Hip and Thigh
Fractures of Femur
Great force required to break femur
Contact sports, BMX, skateboarding, motorcross increase risk
Splint, send to physician, or call EMS

36. Femur Fracture

39. Femoral Neck Fracture Repair

41. Injuries to the Hip and Thigh
Subluxation / Dislocation
Symptoms
1. complete loss of function
2. severe pain
3. deformity
Mechanism of Injury
1. direct blow
2. twisting force

42. Dislocated Hip

44. Subluxation of the hip

45. Injuries to the Hip and Thigh
Contusions
“Charley Horse” = bruise to the quad muscles
Mechanism of Injury
Direct blow to thigh causing bleeding in the muscle tissue
Treatment
1. ICE
2. keep knee flexed while applying ice
3. mild stretching through pain free ROM
** if stretching is not done, blood will pool and leave area vulnerable to myositis ossificans

48. Injuries to the Hip and Thigh
Sprains
Mechanism of injury
1. sudden jerking or twisting motions
2. more frequent in non or poor conditioned athletes
Treatment
PRICE
Stretching & ROM exercises
If injury doesn’t improve within 3 days, send to physician

49. Injuries to the Hip and Thigh
Strains
Most common = hamstrings, hip flexor, adductors and quad
Treatment
ICE
Stretching
Strengthening

50. Injuries to the Hip and Thigh
Bursitis / Synovitis
Most common is inflammation of the trochanter bursa
Mechanism of Injury
1. direct blow
2. repeated stress
Symptoms
1. slight swelling
2. persistent ache
Treatment
1. rest
2. stretching

51. Special Tests for Hip and Pelvis
Thomas Test – hip flexor flexibility
Negative
Positive

52. Iliotibial (IT) Band

53. Special Tests for Hip and Pelvis
Ober’s Test – Iliotibial (IT) band flexibility

54. Stretches for IT Band

55. Special Tests for Hip and Pelvis
Patrick’s or Faber Test – deformity or weakness of the iliopsoas muscle and sacroiliac pain

56. Special Tests for Hip and Pelvis
Trendelenburg Test – hip abductor weakness