1. Chapter 13 Hip, Pelvis, and Thigh Injuries

2. 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

3. 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.

4. 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

6. Anatomy of the Thigh
Pelvis
Ilium
Ischium
Pubis

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

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

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

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

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

12. 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 depending on severity of injury

13. 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...

14. 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

15. 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

16. 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

17. Femur Fractures

18. 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

20. 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

21. 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

22. 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

25. 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

26. 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

27. Hip snapping

28. 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

29. Slipped Capital Femoral Epiphysis
The head of the femur slips off of the neck or shifts position
Found mostly in boys between 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

31. 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

32. 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

33. Groin Strains and Avulsions

34. 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

35. 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

36. Hip, Thigh, and Groin Stretches

37. Hip, Thigh, and Groin Stretches