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The Thigh, Hip, Groin, and Pelvis
Overview
The thigh is continually exposed to traumatic injuries; contusions and strains occur most frequently.
Because of its bony, ligamentous, and muscular arrangements, the hip joint is considered by many to be the
strongest articulation in the body. Though seldom injured, it is subject to muscular strains, contractures, bursitis,
degenerative diseases, and stresses on the epiphyseal and apophyseal growth plates.
The athletic trainer must have a thorough knowledge of the anatomy of the pelvis, hip, groin, and thigh
area to adequately evaluate and manage the common sports injuries associated with this area. The athletic
trainer must also be aware of possible conditions that may occur if injuries are mishandled. A good working
relationship with the team physician will help the athletic trainer give the care needed to ensure that athletes
stay healthy and able to perform at peak levels.
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Anatomy of the Thigh
1. Bones
a. The thigh is the part of the leg between the hip and the knee
b. Femur is the longest and strongest bone in the body – designed to
permit maximum mobility and support during movement
2. Thigh Musculature
a. Anterior Compartment: Sartorius and Quadriceps Femoris group
(Rectus Femoris, Vastus Lateralis, Vastus Medialis, and Vastus
Intermedias)
b. Posterior Compartment: Hamstrings (Biceps Femoris,
Semitendinosus, and Semimembranosus)
c. Medial Compartment: Adductor Magnus, Adductor Longus,
Adductor Brevis, Pectineus and Gracilis
Functional Anatomy of the Thigh
1. Quadriceps inserts by a common tendon to the proximal patella
2. Rectus Femoris is the only quadriceps muscle to cross the hip
3. Hamstrings cross the knee joint posteriorly and all cross the hip except the
short head of the biceps femoris
Assessment of the Thigh
1. History
2. Observation
3. Palpation
4. Special Tests
Recognition and Management of Thigh Injuries
1. Quadriceps Contusion
a. Grade 1: No restriction of range of motion
b. Grade 2: Inability to flex the knee more than 90º
c. Grade 3: Knee flexion ROM is 90º - 45º
d. Grade 4: Knee flexion ROM limited to 45º or less
2. Myositis Ossificans Traumatica
a. A single severe blow
b. Many blows to a muscle area
c. Improper care of a contusion
1. Attempts to “run off” a quad contusion
2. Too – vigorous treatment (massage, ultrasound or superficial
heat to the contused area)
3. Quadriceps Muscle Strains
4. Hamstring Muscle Strains (Grade 1, 2 and 3)
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5. Acute Femoral Fractures
a. Hip is usually externally rotated, slightly adducted and may appear
shortened
6. Femoral Stress Fractures
Anatomy of the Hip, Groin, and Pelvic Region
1. Bones
a. Pelvic girdle is a bony ring formed by the two innominate bones
(ilium, ischium and pubis), the sacrum and the coccyx
b. Functions of the Pelvis
1. Support the spine and trunk and to transfer their weight to
the lower limbs
2. Serves as place of attachment for trunk and thigh muscles
2. Articulations
a. Sacroiliac joint and Coccyx
b. Hip Joint formed by femur articulating with the acetabulum
3. Ligaments, Joint Capsule, and Synovial Membrane
a. Surrounding the acetabular rim is the glenoid labrum
b. Capsule is reinforced by the iliofemoral, pubocapsular, and
ischiocapsular ligaments
c. Hyaline cartilage covers the femoral head
d. Ligamentum teres (attaches to the fovea capitis) – function is to
transport nutrients to the head of the femur
e. Ligaments reinforce the hip joint
1. Iliofemoral Ligament (Y ligament of Bigelow): strongest
ligament in the body – prevents hyperextension, controls
external rotation and adduction of the thigh and limits the
pelvis during backward rolling of the femoral head during
weight bearing
2. Pubofemoral Ligament: Prevents excessive abduction of the
thigh
3. Ischiofemoral Ligament: Prevents excessive internal rotation
and adduction of the thigh
4. Hip Musculature (See Table 21-4)
a. Anterior Hip Muscles: Iliacus, Psoas Major and Minor
b. Posterior Hip Muscles: Tensor Fasciae Latae, Gluteus Maximus,
Medius and Minimus, and the external rotators (Piriformis, Superior
Gemellus, Inferior Gemellus, Obturator Internus, Obturator Externus
and Quadratus Femoris)
5. Bursae
a. Iliopsoas Bursa
b. Deep Trochanteric Bursa
6. Blood Supply
a. Arteries: Aorta divides into two common iliac arteries
b. Veins: Common Iliac Vein, Internal Iliac Vein, and the External Iliac
Vein
Functional Anatomy of the Hip, Groin, and Pelvic Region
1. The Pelvis moves in three directions:
a. Anteroposterior Tilting: Iliopsoas, other hip flexors and lumbar spine
extensors tilt pelvis anteriorly; gluteus maximus, hamstrings, rectus
abdominus, and obliques tilt pelvis posteriorly
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b. Hip abductors or adductors tilt pelvis laterally
c. Gluteal muscles, external rotators, adductors, pectineus and iliopsoas
act together to create rotation in the transverse plane
d. Hip joint is a true ball-in-socket joint
Assessment of the Hip, Groin, and Pelvis
1. History
2. Observation
a. Postural Asymmetry
b. Standing on one leg
c. Ambulation
3. Palpation
4. Special Tests
a. Measuring Leg Length Discrepancy
1. Anatomical Discrepancy: measure between medial malleoli
and ASIS
2. Functional Discrepancy: Umbilicus to the medial malleoli of
each ankle
Recognition and Management of Specific Hip, Groin, and Pelvic Injuries
1. Hip Joint
a. Groin Strain
b. Trochanteric Bursitis
c. Sprains of the Hip Joint
d. Dislocated Hip Joint
e. Avascular Necrosis
f. Snapping Hip Phenomenon
2. Pelvic Conditions
a. Contusion (Hip Pointer)
b. Osteitis Pubis
c. Athletic Pubalgia
d. Stress Fractures
e. Avulsion Fractures and Apophysitis