Download presentation
1
Unit 21: The Thigh, Hip, Groin, and Pelvis
2
Anatomy of the Pelvis, Thigh, and Hip
5
Bony Anatomy Pelvic Girdle Ilium Iliac crest
Anterior superior iliac spine Posterior superior iliac spine Anterior inferior iliac spine
6
Ischium Pubis Acetabulum Ischial tuberosity
Hamstring or bursa problems Should sit on this area of pelvis Pubis Pubic symphysis Acetabulum
8
Femur Head Neck Greater trochanter Lesser trochanter Shaft
Medial condyle Lateral condyle
10
Ligaments - Major source of strength
Ligamentum teres-head of femur Iliofemoral ligament Y ligament Strongest in the body Prevents hyperextension, external rotation, abduction
11
Ischiofemoral ligament
Pubofemoral ligament Prevents abduction Ischiofemoral ligament Prevents medial rotation
12
Bursa 18 in hip Ischial bursa Greater trochanteric bursa Iliopsoas
Found at attachment of gluteus maximus and IT band Iliopsoas
14
Muscles Flexors Anterior thigh (quads) Iliopsoas Rectus femoris (quad)
Sartorius Anterior thigh (quads) Vastus medialis Vastus lateralis Vastus intermedialis
15
Extensors Abductors Gluteus maximus Semitendonosis (hamstring)
Semimembranosis (hamstring) Biceps femoris (hamstring) Abductors Gluteus medius Gluteus minimus Tensor fascia latae (Iliotibial band)
16
Adductors Adductor magnus Adductor brevis Adductor longus Pectineus
Gracilis
18
External Rotators Oburator externus Obturator internus
Quadratus femoris Piriformis – sciatic nerve goes through it. Gamellus superior Gamellus inferior Gluteus maximus
19
Internal Rotators Gluteus minimus Tensor fascia Latae Gluteus medius
20
Assessment of the Thigh
History Onset (sudden or slow?) Previous history? Mechanism of injury? Pain description, intensity, quality, duration, type and location?
21
Observation Postural symmetry?
Size, deformity, swelling, discoloration? Skin color and texture? Is athlete in obvious pain? Is the athlete willing to move the thigh?
22
Palpation Soft tissue of the thigh (anterior, posterior, medial, lateral) should be palpated for pain and tenderness Bony palpation should also be performed to locate areas of pain/discomfort Utilize palpation to assess body symmetry
23
Special Tests Thomas Test Thomas test Straight Leg Raise
Test for hip contractures Straight Leg Raise Test for hip extensor tightness Can also be used to assess low back or SI joint dysfunction Thomas Test
24
Trendelenburg Test Gluteus medius Ober’s/Noble Test IT Band Fulcrum
25
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
26
Thigh Injuries Quadriceps Contusions 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
27
Quad Contusion
28
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
29
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 If condition is recurrent it may indicate problem with blood clotting
30
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)
32
Quadriceps Muscle Strain
Cause of Injury Sudden stretch-falls on bent knee or experiences sudden contraction Weakness or over constricted muscle Signs of Injury Peripheral tear causes fewer sx than deeper tear Pain, pt tenderness, spasm, loss of function and little discoloration Complete tear may leave athlete w/ little disability/discomfort but with some deformity
33
Care RICE to control internal bleeding
Determine extent of injury early Neoprene sleeve may provide some added support
35
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 Grade 2 - partial tear, identified by sharp snap or tear, severe pain, and loss of function
36
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 – increase pain, swelling, palpable swelling/defect? Grade 3 - Rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap
37
Care RICE Restrict activity until soreness has subsided
Ballistic stretching and explosive sprinting should be avoided initially
39
Acute Femoral Fractures
Cause of Injury Generally involves shaft, requires great force Occurs in middle 1/3 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
40
Care Treat for shock, verify neurovascular status, splint before moving, reduce following X-ray Secure immediate emergency assistance and medical referral
41
8 foot fall
42
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 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
44
Hip, Groin, and Pelvic Injuries
Groin Strain Cause of Injury One of the more difficult problems to diagnose Early part of season due to poor strength and flexibility Running, jumping, twisting w/ hip external rotation or severe stretch
45
Signs of Injury Care Sudden twinge or tearing during active movement
Produce pain, weakness, and internal hemorrhaging Care RICE, NSAID’s and analgesics for hours Determine exact muscle or muscles involved Rest is critical Restore normal ROM and strength -- provide support w/ wrap Refer to physician if severe groin pain is experienced
46
Sprains of the Hip Joint
Cause of Injury Result of violent twist due to forceful contact Force from opponent/object or trunk forced over planted foot in opposite direction Signs of Injury Signs of acute injury and inability to circumduct hip Pain in hip region, w/ hip rotation increasing pain
47
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
48
Dislocated Hip Cause of Injury Signs of Injury Rarely occurs in sport
Result of traumatic force directed along the long axis of the femur Signs of Injury Flexed, adducted and internally rotated hip Palpation reveals displaced femoral head, posteriorly Serious pathology Soft tissue, neurological damage and possible fx
49
Care Immediate medical care (blood and nerve supply may be compromised) Contractures may further complicate reduction 2 weeks immobilization and crutch use for at least one month
50
7 y/o posterior hip dislocation skate board fall
51
Posterior Hip Dislocation
injury footage
52
Anterior Hip Dislocation
Notice leg position
53
Hip Problems in the Young Athlete
Legg-Perthes Disease (Coxa Plana) Cause of Condition Avascular necrosis of femoral head: children 4-10 y/o Articular cartilage becomes necrotic, flattens Signs of Condition Pain in groin, can refer to abdomen or knee Limping is also typical Varying onsets and may exhibit limited ROM
54
Legg-Perthes Disease (continued)
Care Bed rest-reduce chance of chronic condition Brace to avoid direct weight bearing Early treatment-head may reossify and revascularize Complication If not treated early, will result in ill-shaping and osteoarthritis in later life
55
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 over weeks or months Hip/knee pain during PROM,AROM; limited abd, flex,med. rotation and limp Management W/ minor slippage, rest and non-weight bearing may prevent further slippage Major displacement requires surgery If undetected/surgery fails severe problems
56
Iliac Crest Contusion (hip pointer)
Cause of Injury Contusion of iliac crest or abdominal musculature Result of direct blow Signs of Injury Pain, spasm, and transitory paralysis of soft structures Decreased rotation of trunk or thigh/hip flexion due to pain
57
Care RICE for at least 48 hours, NSAID’s,
Bed rest 1-2 days in severe cases Referral must be made, X-ray
58
Osteitis Pubis Cause of Injury Signs of Injury Management
Seen in distance runners Repetitive stress on pubic symphysis and adjacent muscles Signs of Injury Chronic pain, inflam. of groin Pt tenderness on pubic tubercle Pain w/ running, sit-ups and squats Management Rest, NSAID’s and gradual RTP
59
Acute Fracture of Pelvis
Cause of Injury Result of direct blow or blunt trauma Signs of Injury Severe pain, loss of function, shock Care Immediately treat for shock Refer to physician Seriousness of injury dependent on extent of shock and possibility of internal injury
60
Stress Fractures Cause of injury Signs of Injury Care
Repetitive abnormal overused forces Signs of Injury Groin pain, w/ aching sensation in thigh that increases w/ activity and decreases w/ rest Discomfort increases with activity and subsides during rest Care Refer to physician for assessment and X-ray Rest for 2-5 months
61
Avulsion Fractures Cause of Injury What muscles can cause avulsion fx?
Avulsions seen in sports w/ sudden accelerations and decelerations What muscles can cause avulsion fx? Signs of Injury Sudden localized pain w/ limited movement Pain, swelling, point tenderness Care Rest, limited activity and graduated exercise
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.