1. The Thigh, Hip and Pelvis

3. Anatomy of the pelvis

4. Bony and Muscular Anatomy

5. Additional Views

6. Can you identify?

7. Can you identify?

8. Quad Contusion Cause of Injury Signs 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

9. Care RICE and NSAID’s Crutches for more severe cases
Isometric quadriceps contractions should begin as soon as tolerated
Heat, massage and ultrasound to prevent myositis ossificans
Padding may be worn for additional protection upon return to play

10. Myositis Ossificans Traumatica
Cause of Injury
Formation of ectopic bone following repeated blunt trauma
Signs of Injury
X-ray shows calcium deposit 2-6 weeks following injury
Pain, weakness, swelling, decreased ROM
Tissue tension and point tenderness
Care
Treatment must be conservative
May require surgical removal if too painful and restricts motion (after one year - remove too early and it may come back)
If condition is recurrent it may indicate problem with blood clotting

11. Quadriceps Muscle Strain
Cause of Injury
Sudden stretch when athlete falls on bent knee or experiences sudden contraction
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
Care
Rest, ice and compression to control internal bleeding
Determine extent of injury early
Neoprene sleeve may provide some added support

12. 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

13. Hamstring Muscle Strains, cont.
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

14. Acute Femoral Fractures
Cause of Injury
Generally involving shaft and requiring great force
Occurs in middle third due to structure and point of contact
Signs of Injury
Shock, pain, swelling, deformity
Must be aware of bone displacement and gross deformity
Loss of function
Care
Treat for shock, verify neurovascular status, splint before moving, reduce following X-ray
Secure immediate emergency assistance and medical referral

15. Femoral Stress Fractures
Cause of Injury
Overuse
Females who are amenorrheic are more vulnerable to stress fx
Signs of Injury
Persistent pain in thigh
X-ray or bone scan will reveal fracture
Commonly seen in femoral neck
Management
Analgesics, NSAID’s RICE
ROM and PRE exercises are carried out w/ pain free ROM
Rest, limited weight bearing

16. Legg-Perthes Disease (Coxa Plana)
Cause of Condition
Avascular necrosis of the femoral head in child age 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

17. Cont. Care Complication 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