1. Anatomy & Injuries to the Thigh, Hip and Pelvis
SP Sports Medicine
John Hardin
Instructor

2. General Information about the pelvis
This area of body is strong and stable
Great demand placed on this part of body—”core”
Functions:
support the spine & trunk
Transfer weight to lower extremities
Place for muscle attachment of thigh and trunk
Protect organs of pelvic region

3. Anatomy
Bones
Muscles
Ligaments

4. Bones
Femur
Head, neck, greater trochanter, lesser trochanter, shaft, medial & lateral condyle and epicondyles
Pelvis
Ilium: iliac crest, ASIS, AIIS, PSIS
Ishcium: ischial tuberosity
Pubis: Pubic symphysis
Acetabulum

5. Bones-the anterior femur

6. The posterior femur

7. The pelvis

8. Muscles Hip Flexors: Hip Extensors: Iliacus & psoas major= Iliopsoas
Rectus femoris
Sartorius
Hip Extensors:
Hamstrings-biceps femoris, semitendinosus, semimembranosus
Gluteus maximus

9. Muscles Knee flexors: Knee extensors: Hamstrings, gastrocnemius
Quadriceps—rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

10. Muscles

11. Muscles

12. Muscles

13. Muscles Hip Adductors: Hip Abductors:
Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus
Hip Abductors:
Gluteus medius, tensor fascia latae

14. Muscles

15. Muscles

16. Muscles Hip Internal rotators: Hip External rotators:
Tensor fascia latae, gluteus minimus
Hip External rotators:
Gluteus maximus, gluteus medius, piriformis

17. Ligaments Thickening of joint capsule allows for very stable joint
Iliofemoral
Ischiofemoral
pubofemoral
Ligamentum Teres
Also called the round ligament
Attaches head of femur into acetabulum allowing blood supply to that area

18. Ligaments

19. Preventing injuries to thigh/hip
Flexibility training and stretching
Strength training
Proper protective equipment

20. Common Injuries
Strains
Sprains
Contusions
Fractures
Dislocations

21. Strains
Quads
Hamstrings
Groin (adductors)
Hip flexors
Gluteals

22. Strains Mxn: sudden strong contraction of muscle(s)
overstretching of muscle(s)
Muscle strength imbalance

23. Strains-hamstring

24. Strains- groin

25. Strains S/S: pain/discomfort POT
Bleeding causing discoloration (after 1-2 days)
Loss of function
Muscle spasm
deformity

26. Strains TX: RICE modify/restrict activity crutches if necessary
Medical referral if necessary
Restore normal ROM flexibility and strength using various modalities as needed

27. Strains Complications:
recurrent strains due to “inelasticity of scar tissue” especially at that same site
Excess buildup of scar tissue

28. Strains-quad after the fact

29. Strains-quad

30. Strains-hamstring

31. Strains-hamstring

32. Hamstring strain treatment

33. Hamstring avulsion

34. Contusions
Quadriceps
Hip pointer

35. Quadriceps Contusion Mxn:
direct blow to relaxed thigh compressing the musculature again the femur

36. Quadriceps Contusion S/S: Pain POT Bleeding into the muscle Swelling
Temporary loss of function

37. Quad contusion Tx: RICE w/ knee flexed Crutches if necessary
Restore normal ROM, flexibility & strength
Ultrasound
Heat
Medical referral if needed

38. Quad contusion Complication:
Myositis ossificans—formation of bony tissue within the muscle
Very painful
Greatly restricts ROM mainly flexion
Caused by:
severe blow that is not properly cares for
Repeated blows to same area

39. Myositis Ossificans

40. Hip Pointer
Mxn:
direct blow to the iliac crest and/or ASIS

41. S/S: Pain Spasm Bleeding in the area—discloration
Temporary loss of motion
Unable to rotate trunk or flex hip without pain

42. Hip Pointer

43. Hip Pointer Tx: RICE Bed rest if necessary
Medical referral if necessary
Return to activity when pain if gone and motion is restored

44. Fractures-Avulsion Most common at ASIS or Ischial Tuberosity
Mxn: forceful contraction of muscle

45. Avulsion Fractures S/S: Extreme pain with movement & weight bearing
POT (either over the ASIS or Ischial tub.)
Bleeding/discoloration

46. Avulsion
TX:
Ice
crutches
Medical referral for x-ray

47. Fractures- femur Occurs most often in the shaft of the femur Mxn:
great force-direct or indirect- placed on the femur

48. Femur Fractures S/S: Pain POT
Deformity w/ thigh externally rotated, shortened
Loss of motion/function
Swelling due to internal bleeding
Muscle spasms
Muscle lacerations

49. Femur fractures
Can be life threatening—fatty tissue and bone marrow can get into the blood stream and cause a blood clot

50. Femur Fracture Tx: Call 911 Don’t move the athlete
Hare traction splint
Check for distal pulse
Control any external bleeding
Treat for shock

51. Femur fractures

52. Femur fractures

53. Femoral Stress Fracture
Mxn: repetitive stress of the pounding of the lower extremity which causes the femur to bend (one side is compressed the other is stretched)

54. Femoral stress fracture
POT at one specific site
Pain with activity
Pain with a compressive force at the site (sitting on edge of table)

55. Femoral Stress fracture
Tx:
Rest
Alternate activity—non-weight bearing
Crutches if limping
Medical referral---x-rays and bone scan or--

56. Femoral stress fx

57. Slipped Capital Femoral Epiphysis
Growth plate injury (epiphyseal fracture)
Occurs at the capital femoral epiphysis (where neck joins the head of femur)
More common in boys yrs.
Tall and thin
obese

58. Slipped Capital femoral epiphysis
Mxn:
Not know but may be related to effects of a growth hormone
In ¼ of cases both hips are affected

59. Slipped---epiphysis S/S: Pain in groin area that
arises suddenly as a result of trauma
arises slowly over weeks or months as a result of prolonged stress
Early signs minimal but later get pain in hip and knee
Major limitations with movement
Limp when walking

60. Slipped --- epiphysis TX: Minor cases Major cases Rest
Non-weight bearing to prevent further slippage
Medical referral
Major cases
Surgery to repair “fracture” usually put pins into bone to keep in place and allow for proper healing

61. Slipped---epiphysis Complications:
If displacement goes undetected or if surgery fails to restore normal hip mechanics can have problems later in life
Bone doesn’t grow properly
Head of femur doesn’t grow properly
Bone spurs
Arthritis

62. SCFE

63. SCFE

64. SCFE
Pins to fix

65. Legg-Calve-Perthes Disease
Disruption of blood flow to the head of femur causing the bone tissue to die and become flattened
Occurs in children 3-12 yrs
Occurs in boys 4 times more often than girls
Usually occurs in first born
Affect usually only one hip

66. LCPD
Mxn: Unknown
S/S:
complaints of pain in groin, and sometimes referred pain to abdomen or knee
Limited hip movement

67. LCPD Tx: Medical referral Bed rest or non-weight bearing
If treated in time, the head of femur will revascularize and regain its normal shape (the old cells that die will be resorbed and new bone cells laid down to take their place)

68. LCPD

69. LCPD
Complications:
If not treated early enough, the head of femur will be ill (abnormally) shaped producing osteoarthritis in later life

70. Hip Dislocation Rarely occurs in sports Most are posterior
Mxn: traumatic force along the long axis of the femur such as falling on one side with the knee bent (and landing on that bent knee) forcing head of femur posteriorly

71. Hip Dislocation S/S: Hip in flexion, adduction, and internal rotation
Deformity posterior—head of femur can be palpated through gluteal muscle
Extreme pain
Inability to move at hip joint

72. Hip Dislocation

73. Hip Dislocation

74. Hip Dislocation TX: Call 911 Don’t move athlete
Splint in position you find them
Treat for shock

75. Hip Dislocation Complications:
Tears in the vascular and nerve structures
Blood vessels to ligamentum teres may be torn (as will the ligament itself)
Sciatic nerve may be damaged
Paralysis of muscles in the area
Atrophic necrosis (degeneration of femoral head)