Chapter 21: The Thigh, Hip, Groin, and Pelvis

Activity- Anatomy Review

Lower Extremity

Assessment of the Thigh, Hip and Pelvis

• History– Onset (sudden or slow?)– Previous history?– Mechanism of injury?– Pain description, intensity, quality, duration,

type and location?• Observation

– Symmetry?– Size, deformity, swelling, discoloration?– Skin color and texture?– Is athlete in obvious pain?– Is the athlete willing to move the thigh?

• Observation– Symmetry- hips, pelvis tilt (anterior/posterior)

• Lordosis or flat back

– Lower limb alignment • Knees, patella, feet

– Pelvic landmarks (ASIS, PSIS, iliac crest)– Standing on one leg

• Pubic symphysis pain or drop on one side

– Ambulation• Walking, sitting - pain will result in movement

distortion

Leg Length Discrepancy Measures

Contusions

• Quadriceps Contusions– Etiology

• Blunt Trauma

– Signs and Symptoms

• Pain• transitory loss of

function• Immediate swelling

and deformity• Grades 1-3

Myositis Ossificans

• Myositis Ossificans Traumatica– Etiology

• Inflammation of the muscle leading to bone formation

– Signs and Symptoms• X-ray shows calcium

deposit 2-6 weeks following injury

• Pain, weakness, swelling, tissue tension and point tenderness w/ decreased ROM

Contusions (cont’d)

• Hip Pointer– Etiology

• Direct blow to iliac crest or abdominal musculature

– Signs and Symptoms• Pain, spasm, and

transitory paralysis of soft structures

• Pain is extreme• Obvious swelling and

bruising• Decreased trunk and

hip ROM

Myositis Ossificans is:

25%

25%25%

25%

1 2 3 4

1. An inflammation of bone

2. An inflammation resulting in bone formation

3. An inflammation resulting in ecchymosis

4. None of the above

Strains• Quadriceps Muscle Strain

– Etiology• Sudden stretch when athlete falls on bent knee

or experiences sudden contraction• Associated with weakened or over constricted

muscle

– Signs and Symptoms• Peripheral tear causes fewer symptoms than

deeper tear• Pain, point tenderness, spasm, loss of function

and little discoloration• Grades 1-3

Strains (cont’d)• Groin Strain

– Etiology• One of the more difficult problems to diagnose• Injury to one of the muscles in the regions (generally

adductor longus)• Occurs from running , jumping, twisting w/ hip external

rotation or severe stretch

– Signs and Symptoms• Pain with forced hip adduction, adduction, rotation,

extension• Decreased ROM• May be a deformity, swelling, bruising• Grades 1-3

Strains (cont’d)• Hamstring Muscle

Strains– Etiology

• Multiple theories of injury– Most commonly due to

a forceful eccentric contraction

– Signs and Symptoms• Pain, decreased ROM,

decreased strength, point tenderness, deformity, bruising

• Grades 1-3

A 3rd degree hamstring strain will result in:

20%

20%20%

20%

20%

1 2 3 4 5

1. Mild pain2. Moderate

swelling3. Loss of function4. All of the above5. None of the

above

A 2nd degree quadriceps contusion will result in:

20%

20%

20%

20%

20%

1 2 3 4 5

1. Mild pain2. Moderate

swelling3. Loss of function4. All of the above5. None of the

above

FracturesFemoral Fractures

– Etiology• Generally involving shaft and

requiring a great deal of force

• Occurs in middle third due to structure and point of contact

– Signs and Symptoms• Pain, swelling, deformity• Muscle guarding, hip is

adducted and ER• Leg with fx may also be

shorter• Potential serious

neurovascular complications

Overuse injuries (cont’d)• Trochanteric Bursitis

(Snapping Hip)– Etiology

• Inflammation at the site where the gluteus medius inserts or the IT-band passes over the trochanter

– Signs and Symptoms• Complaint of lateral hip

pain that may radiate down the leg

• Palpation reveals tenderness over lateral aspect of greater trochanter

• May hear an audible snap

Osteitis Pubis

• Etiology– Seen in distance runners– Repetitive stress on pubic symphysis

and adjacent muscles– Acute case may be the result of

bicycle seat

Dislocations• Dislocated Hip

– Etiology• Rarely occurs in sport• Result of traumatic force

directed along the long axis of the femur (posterior dislocation w/ hip flexed and adducted and knee flexed)

– Signs and Symptoms• Flexed, adducted and

internally rotated hip• Palpation reveals displaced

femoral head posteriorly• Serious pathology

– Soft tissue, neurological damage and possible fx

Hip dislocations rarely occur in sports.

1 2

50%50%1. True2. False

Hip Problems in the Young Athlete

• Legg Calve’-Perthes Disease (Coxa Plana)– Etiology

• Avascular necrosis of the femoral head in child ages 4-10

• Slipped Capital Femoral Epiphysis

– Etiology• Found mostly in boys ages 10-17 who are

characteristically tall and thin or obese• May be growth hormone related• 25% of cases are seen in both hips, trauma accounts for

25%• Head slippage on X-ray appears posterior and inferior

Avulsion Fractures and Apophysitis

• Etiology• Traction epiphysis

(bone outgrowth)• Common sites include

ischial tuberosity, AIIS, and ASIS

• Avulsions seen in sports w/ sudden accelerations and decelerations

• May occur insidiously– Signs and Symptoms

• Sudden localized pain w/ limited movement

• Pain, swelling, point tenderness

• Muscle testing increases pain