Download Anatomy & Injuries to the Thigh, Hip and Pelvis

Anatomy & Injuries to the Thigh,
Hip and Pelvis
SP Sports Medicine
John Hardin
Instructor
General Information about the
pelvis
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This area of body is strong and stable
Great demand placed on this part of body—
”core”
Functions:
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support the spine & trunk
Transfer weight to lower extremities
Place for muscle attachment of thigh and trunk
Protect organs of pelvic region
Anatomy
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Bones
Muscles
Ligaments
Bones
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Femur
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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
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Bones-the anterior femur
The posterior femur
The pelvis
Muscles
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Hip Flexors:
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Iliacus & psoas major= Iliopsoas
Rectus femoris
Sartorius
Hip Extensors:
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Hamstrings-biceps femoris, semitendinosus,
semimembranosus
Gluteus maximus
Muscles
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Knee flexors:
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Hamstrings, gastrocnemius
Knee extensors:
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Quadriceps—rectus femoris, vastus lateralis,
vastus medialis, vastus intermedius
Muscles
Muscles
Muscles
Muscles
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Hip Adductors:
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Adductor magnus, adductor longus, adductor
brevis, gracilis, pectineus
Hip Abductors:
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Gluteus medius, tensor fascia latae
Muscles
Muscles
Muscles
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Hip Internal rotators:
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Tensor fascia latae, gluteus minimus
Hip External rotators:
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Gluteus maximus, gluteus medius, piriformis
Ligaments
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Thickening of joint capsule allows for very
stable joint
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Iliofemoral
Ischiofemoral
pubofemoral
Ligamentum Teres
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Also called the round ligament
Attaches head of femur into acetabulum
allowing blood supply to that area
Ligaments
Preventing injuries to thigh/hip
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Flexibility training and stretching
Strength training
Proper protective equipment
Common Injuries
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Strains
Sprains
Contusions
Fractures
Dislocations
Strains
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Quads
Hamstrings
Groin (adductors)
Hip flexors
Gluteals
Strains
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Mxn:
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sudden strong contraction of muscle(s)
overstretching of muscle(s)
Muscle strength imbalance
Strains-hamstring
Strains- groin
Strains
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S/S: pain/discomfort
POT
Bleeding causing discoloration (after 1-2
days)
Loss of function
Muscle spasm
deformity
Strains
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TX: RICE
modify/restrict activity
crutches if necessary
Medical referral if necessary
Restore normal ROM flexibility and
strength using various modalities as
needed
Strains
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Complications:
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
Contusions
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Quadriceps
Hip pointer
Quadriceps Contusion
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Mxn:
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direct blow to relaxed thigh compressing the
musculature again the femur
Quadriceps Contusion
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S/S:
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Pain
POT
Bleeding into the muscle
Swelling
Temporary loss of function
Quad contusion
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Tx: RICE w/ knee flexed
Crutches if necessary
Restore normal ROM, flexibility & strength
Ultrasound
Heat
Medical referral if needed
Quad contusion
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Complication:
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Myositis ossificans—formation of bony tissue
within the muscle
Very painful
 Greatly restricts ROM mainly flexion
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Caused by:
severe blow that is not properly cares for
 Repeated blows to same area
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Myositis Ossificans
Hip Pointer
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Mxn:
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direct blow to the iliac crest and/or ASIS
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S/S:
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Pain
Spasm
Bleeding in the area—discloration
Temporary loss of motion
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Unable to rotate trunk or flex hip without pain
Hip Pointer
Hip Pointer
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Tx:
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RICE
Bed rest if necessary
Medical referral if necessary
Return to activity when pain if gone and
motion is restored
Fractures-Avulsion
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Most common at ASIS or Ischial
Tuberosity
Mxn: forceful contraction of muscle
Avulsion Fractures
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S/S:
Extreme pain with movement & weight
bearing
POT (either over the ASIS or Ischial tub.)
Bleeding/discoloration
Avulsion
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TX:
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Ice
crutches
Medical referral for x-ray
Fractures- femur
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Occurs most often in the shaft of the
femur
Mxn:
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great force-direct or indirect- placed on the
femur
Femur Fractures
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S/S:
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Pain
POT
Deformity w/ thigh externally rotated,
shortened
Loss of motion/function
Swelling due to internal bleeding
Muscle spasms
Muscle lacerations
Femur fractures
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Can be life threatening—fatty tissue and
bone marrow can get into the blood
stream and cause a blood clot
Femur Fracture
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Tx:
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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
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Mxn: 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
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S/S:
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POT 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
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Tx:
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Rest
Alternate activity—non-weight bearing
Crutches if limping
Medical referral---x-rays and bone scan or--
Femoral stress fx
Slipped Capital Femoral
Epiphysis
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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.
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Tall and thin
obese
Slipped Capital femoral
epiphysis
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Mxn:
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Not know but may be related to effects of a
growth hormone
In ¼ of cases both hips are affected
Slipped---epiphysis
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S/S:
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Pain in groin area that
arises suddenly as a result of trauma
 arises slowly over weeks or months as a result of
prolonged stress
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Early signs minimal but later get pain in hip
and knee
Major limitations with movement
Limp when walking
Slipped --- epiphysis
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TX:
Minor cases
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Rest
Non-weight bearing to prevent further
slippage
Medical referral
Major cases
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Surgery to repair “fracture” usually put pins
into bone to keep in place and allow for
proper healing
Slipped---epiphysis
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Complications:
If displacement goes undetected or if
surgery fails to restore normal hip
mechanics can have problems later in life
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Bone doesn’t grow properly
Head of femur doesn’t grow properly
Bone spurs
Arthritis
SCFE
SCFE
SCFE
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Pins to fix
Legg-Calve-Perthes Disease
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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
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Mxn: Unknown
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S/S:
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complaints of pain in groin, and sometimes
referred pain to abdomen or knee
Limited hip movement
LCPD
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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
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Complications:
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If not treated early enough, the head of
femur will be ill (abnormally) shaped
producing osteoarthritis in later life
Hip Dislocation
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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
Hip Dislocation
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S/S:
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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
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TX:
Call 911
Don’t move athlete
Splint in position you find them
Treat for shock
Hip Dislocation
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Complications:
Tears in the vascular and nerve structures
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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)