Anatomy & Anatomy & Injuries to Injuries to the Thigh, the Thigh, Hip and Hip and PelvisPelvis

General Information about General Information about the pelvisthe pelvis This area of body is strong and stableThis area of body is strong and stable Great demand placed on this part of Great demand placed on this part of

body—”core”body—”core” Functions: Functions:

support the spine & trunksupport the spine & trunk Transfer weight to lower extremitiesTransfer weight to lower extremities Place for muscle attachment of thigh and Place for muscle attachment of thigh and

trunktrunk Protect organs of pelvic regionProtect organs of pelvic region

Anatomy Bones Muscles Ligaments

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

Bones-the anterior femur

The posterior femur

The pelvis

MusclesHip Flexors:

Iliacus & psoas major= Iliopsoas

Rectus femorisSartorius

Hip Extensors:Hamstrings-biceps

femoris, semitendinosus, semimembranosus

Gluteus maximus

Muscles Knee flexors:

Hamstrings, gastrocnemius Knee extensors:

Quadriceps—rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

Muscles

Muscles

Muscles Hip Adductors:

Adductor magnus, adductor longus, adductor brevis, (Adductors) gracilis, pectineus

Hip Abductors: Gluteus medius, tensor fascia latae

Muscles

Muscles Hip Internal rotators:

Tensor fascia latae, gluteus minimus Hip External rotators:

Gluteus maximus, gluteus medius, piriformis

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

Ligaments

Hip Movements

Hip Hip FlexioFlexionn

Preventing injuries to thigh/hip

Flexibility training and stretchingFlexibility training and stretchingStrength trainingStrength trainingProper protective equipmentProper protective equipment

Common Injuries Strains Sprains Contusions Fractures Dislocations

Strains Quads Hamstrings Groin (adductors) Hip flexors Gluteals

Strains MOI:

sudden strong contraction of muscle(s) overstretching of muscle(s) Muscle strength imbalance

Strains-hamstring

Strains- groin

Strains S/S: pain/discomfort Pt. tender Bleeding causing discoloration (after 1-2

days) Loss of function Muscle spasm deformity

Strains TX: RICE modify/restrict activity crutches if necessary Medical referral if necessary Restore normal ROM flexibility and

strength using various modalities as needed

StrainsComplications:recurrent strains due to

“inelasticity of scar tissue” especially at that same site

Excess buildup of scar tissue

Strains-quad after the fact

Strains-quad

Strains-hamstring

Strains-hamstring

Hamstring strain treatment

Hamstring avulsion

HAMSTRING WRAP 6” Double ACE wrap Start around the leg and work your way

around the waist. Pulling the leg into extension.

Athlete is standing with injured leg out in front.

Athlete’s injured leg has a roll of tape underneath the heel, to slightly flex the muscles.

Groin Wrap 6” Double ACE wrap Start around the leg and work your way

around the waist. Pulling the leg into adduction. Exact same set up as hamstring wrap.

Contusions Quadriceps Hip pointer

Quadriceps Contusion MOI:

direct blow to relaxed thigh compressing the musculature again the femur

Quadriceps Contusion S/S:

Pain Pt. tender Bleeding into the

muscle Swelling Temporary loss of

function

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

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

Quad Contusion Wrap 6 or 4” Single wrap Contusion Pad/Foam

Athlete has heel on roll of tape. Place foam or contusion pad over the

affected area. Use the elastic wrap starting distal to proximal to cover the foam or pad.

Myositis Ossificans

Hip Pointer MOI:

direct blow to the iliac crest and/or ASIS

S/S: Pain Spasm Bleeding in the area—discloration Temporary loss of motion

Unable to rotate trunk or flex hip without pain

Hip Pointer

Hip Pointer Tx:

RICE Bed rest if necessary Medical referral if necessary Return to activity when pain if gone and

motion is restored

Fractures-Avulsion Most common at ASIS or Ischial

Tuberosity

MOI: forceful contraction of muscle

Avulsion Fractures S/S: Extreme pain with movement & weight

bearing Pt. tender (either over the ASIS or Ischial

tub.) Bleeding/discoloration

Avulsion TX:

Ice crutches Medical referral for x-ray

Fractures- femur Occurs most often in the shaft of the

femur

MOI: great force-direct or indirect- placed on

the femur

Femur Fractures S/S:

Pain Pt. tender Deformity w/ thigh externally rotated, shortened Loss of motion/function Swelling due to internal bleeding Muscle spasms Muscle lacerations

Femur fractures Can be life threatening—fatty tissue and

bone marrow can get into the blood stream and cause a blood clot

Femur Fracture Tx:

Call 911 Don’t move the athlete Hare traction splint Check for distal pulse Control any external bleeding Treat for shock

Femur fractures

Femur fractures

Femoral Stress Fracture MOI: repetitive stress of the pounding

of the lower extremity which causes the femur to bend (one side is compressed the other is stretched)

Femoral stress fracture S/S:

Pt. tender at one specific site Pain with activity Pain with a compressive force at the site

(sitting on edge of table) Pain with activity

Femoral Stress fracture Tx:

Rest Alternate activity—non-weight bearing Crutches if limping Medical referral---x-rays and bone scan

or--

Femoral stress fx

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 10-17 yrs.

Tall and thin obese

Slipped Capital femoral epiphysis MOI:

Not know but may be related to effects of a growth hormone

In ¼ of cases both hips are affected

Slipped---epiphysis S/S:

Pain in groin area that arises suddenly as a result of traumaarises 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

Slipped --- epiphysis TX: Minor 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

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

SCFE

SCFE

SCFE Pins to fix

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

LCPD MOI: Unknown

S/S: complaints of pain in groin, and

sometimes referred pain to abdomen or knee

Limited hip movement

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)

LCPD

LCPD Complications:

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

Hip Dislocation Rarely occurs in sports Most are posterior

MOI: 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

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

Hip Dislocation

Hip Dislocation

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

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)

Bo Jackson